Betraying the NHS: health abandoned PDF
Preview Betraying the NHS: health abandoned
‘ThisbookisanimpressiveindictmentofthechangesmaderecentlybytheGovern- menttotheNationalHealthService.Thedamagethesechangeshaveinflictedon thepeopleofSuffolk,especiallytheelderlyandothervulnerablepeople,isdocu- mentedindamningandrelentlessdetail.SadlySuffolkisn’ttheonlyplacewhere promisesarebeingbroken,theprinciplesoftheNHSabandoned,theneedsofcom- munitiesignoredandfinancialtargetsruthlesslypursuedregardlessof theconse- quences. MichaelMandelstam’sanalysisisunanswerableandhiscriticismsrobust.His bookshouldbestudiedbyeveryoneconcernedwithhowhealthcareisdeliveredin Britain. If any of the politicians, civil servants or administrators who devised or implementedthesechangeshavethenervetoreadittheyshouldhangtheirheadsin shame and resign at once. The author has been generous in the book about the contributions other people,includingmyself,havemadetofightingthesechangesandexposingtheir consequences.Thetruthisthatthepersonwhohasdonethemostinthisrespectis MichaelMandelstamhimself.Histirelesswork,persistenceinthefaceofallkinds of bureaucraticandotherobstructionsandhisconsiderableexpertknowledgeof health and social service issues have made him an inspiration to the whole community. I am privileged to have him as one of my constituents.’ – Tim Yeo, MP for South Suffolk and former Health Minister ‘MichaelMandelstamhasvividlyillustratedandauthenticatedhisgrandtheme– thewarrantedcollapseofpublictrustinNHSTrusts–byablow-by-blowaccount ofhospitalclosures,inSuffo lkparticularly.Inthecourseofithetellsofpubliccon- sultationsofshamelessinsincerityandofalmostOrwellian“mantras,euphemism, anddoublethink”.Aboveall,hisisacautionarytaleof ourtimes–of ideological centralisation out of touch with local realities.’ – Lord Phillips of Sudbury, life peer and lawyer Betraying the NHS of related interest Community Care Practice and the Law Third Edition Michael Mandelstam ISBN 1 84310 233 1 Manual Handling in Health and Social Care An A–Z ofLaw and Practice Michael Mandelstam ISBN 1 84310 041 X An A–Z of Community Care Law Michael Mandelstam ISBN 1 85302 560 7 Setting Up New Services in the NHS ‘Just Add Water!’ Kingsley Norton Community, Culture and Change 13 ISBN 1 84310 162 9 Betraying the NHS Health Abandoned Michael Mandelstam Jessica Kingsley Publishers London and Philadelphia First published in 2007 by Jessica Kingsley Publishers 116 Pentonville Road London N1 9JB, UK and 400 Market Street, Suite 400 Philadelphia, PA 19106, USA www.jkp.com Copyright © Michael Mandelstam 2007 All rights reserved. No part ofthis publication may be reproduced in any material form (including photocopying or storing it in any medium by electronic means and whether or not transiently or incidentally to some other use ofthis publication) without the written permission ofthe copyright owner except in accordance with the provisions ofthe Copyright, Designs and Patents Act 1988 or under the terms ofa licence issued by the Copyright Licensing Agency Ltd, 90 Tottenham Court Road, London, England W1T 4LP. Applications for the copyright owner’s written permission to reproduce any part of this publication should be addressed to the publisher. Warning: The doing ofan unauthorised act in relation to a copyright work may result in both a civil claim for damages and criminal prosecution. Library ofCongress Cataloging in Publication Data Mandelstam, Michael, 1956- Betraying the NHS : health abandoned / Michael Mandelstam. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-1-84310-482-7 (hardback : alk. paper) ISBN-10: 1-84310-482-2 (hardback : alk. paper) 1. National health services--Great Britain. 2. Health services administration--Great Britain. 3. Medical policy--Great Britain. I. Title. [DNLM: 1. Great Britain. National Health Service. 2. State Medicine--organization & administration--Great Britain. 3. Delivery ofHealth Care--Great Britain. 4. Health Care Reform --Great Britain. 5. Health Policy--Great Britain. W 225 FA1 M271b 2007] RA395.G6M364 2007 362.10941--dc22 2006025130 British Library Cataloguing in Publication Data A CIP catalogue record for this book is available from the British Library ISBN-13: 978 184310 482 7 ISBN-10: 1 84310 482 2 ISBN eBook pdf: 1 84642 482 2 Printed and bound in Great Britain by Athenaeum Press, Gateshead, Tyne and Wear Contents AUTHOR’S NOTE 9 1. Introduction: the Death Throes of a Health Service 13 2. Comprehensive, Universal and Free 25 New NHS policies: modernising the methods of cultivation 28 All is rosy in the health garden 30 A stony undersoil: less than universality 32 Enforcing frugality with hard legal implements 33 3. Sowing Financial Seeds: the Great Investment 36 Financial whips and local pain: making the countryside smart 39 Rural neglect: financial dips and hollows 40 Dust in the eyes: debts, savings and assurances 42 The financial never-never land ofthe NHS 44 4. Declaring the Health Harvest and Concealing Ruined Crops 49 Setting up the targets and blanking out the rest 49 Visible targets and disappearing services across Suffolk 54 Concealing the ruined health crops 57 Spoliation ofthe health landscape 57 Dissolution ofthe hospitals: turning out the vulnerable, the old and the young 61 Laying waste to the Suffolk health services 64 A spot ofturbulence 65 Patient care will not be affected: the harvest is safe 67 Flattening out the financial bumps 69 Scapegoats and blame: flushing out the health reactionaries 71 5. Uprooting the Traditional Health Fields 75 Taking us all to market: letting loose independent enterprise 76 Fanning out across the private sector 78 Local fields into prairie lands: NHS reorganisation 82 Destabilising the machinery and blighting the crops 83 Payment by piecework: results and tariffs 86 Levelling the fields: business contestability and financial balance 88 6. Cultivation of Local Health Services 91 Rural massacre ofthe community hospitals 92 Follow my White Paper: the Secretary ofState rides out 93 Over the hills, down the dales and all round the houses: chasing the disappearing health services 101 Beyond the bricks and mortar of local hospitals 103 Attacking community hospitals in Suffolk: the PCTs lead the field 105 National rebellion over community hospitals 106 Ripping the heart and history out oflocal communities 108 7. Choosing the Method of Cultivation: Patient Choice 111 Meeting, marching and petitioning 112 The great unrest in Suffolk 116 Ploughing up choice: ‘no’ means ‘yes’ 119 Chorus ofdisapproval: local councils and voluntary bodies raise their voices 122 Dispersal in the mist: playing down the protests and opposition 124 8. Alienating and Spreading Fear in the Community 128 Consulting with the peasants 130 Consulting on the hoof: taking shortcuts and sidewinds 133 Cutting up a PCT: consultation, outrage and anger 137 Alienating and striking fear into local communities 139 Dissolution ofpromises and trust in West Suffolk 141 Cutting the clinicians down to size 149 Waving away the benighted clinicians ofSuffolk 150 Lowering morale ofthe workers 153 9. Combing the Landscape for a Decision-maker 155 Orchestrating the votes ofPCT boards 158 Keeping the non-accountability balloon airborne 161
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