Above all the freedom of the Press is paramount. Censorship or severely restrictive legislation is not an acceptable alternative. We sometimes have to accept the consequences and tolerate a Press that can be wrong, unfair, misleading or more interested in selling newspapers than in the public interest. The Press are our protectors and not out enemy. But there are times when we have to stand back and consider what is being said. Reporting occasionally differs so much from any concept of balanced coverage that questions must be asked. Journalists must search their consciences over what has happened to their principles and ideals.
Unreasonable reporting has arisen with the Health and Social Care Bill to an extent that has played a role in turning both members of the Pubic and medical professionals against the Bill. Normally responsible newspapers and broadcasters, including the BBC, have sometimes been misleading and have contributed to prejudice against the reforms. In this blog I do not have space to consider every case. I therefore focus here on one example that provides a flavour of what I mean. Taken as a one-off situation the implications of this one example are not enormous but the overall pattern is disturbing.
If at the time of writing the words “BBC Health Bill” are fed into Google the first search result listed is:
The relevant BBC story was released on 27th December 2011 and was featured prominently on BBC Television News. The first three paragraphs of the BBC summary reached through the above link read:
“NHS hospitals in England will be free to use almost half their hospital beds and theatre time for private patients under government plans.
A recent revision to the ongoing health bill will allow foundation hospitals to raise 49% of funds through non-NHS work if the bill gets through Parliament.
Most foundation trusts are now limited to a private income of about 2%.”
These opening paragraphs gave the impression that the Government had just proposed a new increase in the limits for non-NHS income in NHS hospitals. In fact, the Bill as passed by the House of Commons to the Lords included no limit at all. The new proposal was therefore to introduce a safeguard ensuring that no NHS hospital will end up principally servicing the non-NHS sector.
The proposed limit of 49% (or, to be precise, below 50%) does not in fact relate directly to hospital beds or theatre time but rather to total non-NHS income in each hospital. Some potential non-NHS income derives from services not relating directly to medical care and should be strongly encouraged as a way of raising funds for the NHS. Certain other non-NHS medical income relates to services that would not be available to NHS patients without the contribution from private patients (e.g. by helping to fund facilities that would otherwise be unavailable such as costly diagnostic equipment). On the basis that hospitals are likely to charge more to private patients than the funding received per NHS patient, it is mathematically hard to see how a hospital can get anywhere near to 49% of hospital beds or theatre time going to private patients unless the hospital provides other important non-NHS services (e.g. for the pharmaceutical industry or in research contracts or as discussed on pages 10-12 of my submission to the Department of Health downloadable here ).
The BBC article goes on to say (paragraphs 4-9):
“The Health Secretary says the move will benefit NHS patients but Labour claimed it could lead to longer waiting lists.
The amendment to a clause of the Health and Social Care Bill was made shortly before Christmas by Health Minister Earl Howe.
Commenting on the move, Health Secretary Andrew Lansley said lifting the private income cap for foundation hospitals would directly benefit NHS patients.
‘If these hospitals earn additional income from private work that means there will be more money available to invest in NHS services,’ he said in a statement.
‘Furthermore services for NHS patients will be safeguarded because foundation hospitals’ core legal duty will be to care for them.
‘But Labour’s shadow Health Secretary Andy Burnham claimed the move could mean longer waits for NHS patients.’ “
Under the Government’s proposals hospitals are required to ensure that NHS patients benefit from non-NHS income and to explain why they do so. It would therefore be illegal for NHS hospitals to increase waiting lists as a result of the provision of non-NHS services unless there were some greater benefit to NHS patients in other ways.
The article from the BBC then quotes Andy Burnham as saying:
“This surprise move, sneaked out just before Christmas, is the clearest sign yet of David Cameron’s determination to turn our precious NHS into a US-style commercial system, where hospitals are more interested in profits than people.
“With NHS hospitals able to devote half of their beds to private patients, people will begin to see how our hospitals will never be the same again if Cameron’s Health Bill gets through Parliament.”
We have no criticism of Andy Burnham at a personal level. He is simply doing what politicians often do in showing political bias. However, the impartiality of the BBC can be criticised because of the prominence to given to his remarks without providing the information necessary to put them in context. The only surprise was in the Government restricting non-NHS income at all. The prime directive of the NHS is to achieve the best clinical outcomes for NHS patients and is not to make a profit. As explained above, hospitals will not normally be free to devote anything like half of their beds to private patients, because to do so would generally breech the total non-NHS income limit and also not be in the interests of NHS patients. In addition, the Government’s proposals will not directly increase the number of private patients. Far too few private patients exist to fill half of NHS hospital beds.
The proposed Government amendment was announced on 15th December 2011 but not reported by the BBC until 27th December. The amendment was agreed by the relevant House of Lords Committee on 15th December after considerable debate involving Shirley Williams (Liberal Democrat). If the Labour Party truly felt the proposal to be as harmful as Andy Burnham has implied, press coverage would have been obtained well before Christmas. A Labour plot to sneak out biased criticism between Christmas and New Year fits the facts better than a Conservative plot to release the news shortly before Christmas, although we have no strong evidence that either has occurred.
The House of Commons debated the non-NHS income limit on 16th January 2012 when Andy Burnham (Labour) moved the following motion:
“That this House believes there is an important role for the private sector in supporting the delivery of NHS care; welcomes the contribution made by private providers to the delivery of the historic 18-week maximum wait for NHS patients; recognises a need, however, for agreed limits on private sector involvement in the NHS; notes with concern the Government’s plans to open up the NHS as a regulated market, increasing private sector involvement in both commissioning and provision of NHS services; urges the Government to revisit its plans, learning from the recent problems with PIP implants and the private cosmetic surgery industry; believes its plan for a 49 per cent. private income cap for Foundation Trusts, in the context of the hospitals as autonomous business units and a ‘no bail-outs’ culture, signals a fundamental departure from established practice in NHS hospitals; fears that the Government’s plans will lead to longer waiting times, will increase health inequalities and risk putting profits before patients; is concerned that this House has not been given an opportunity to consider such a significant policy change; and calls on the Government to revise significantly downwards its proposed cap on the level of private income that can be generated by NHS hospitals.”
The wording of this motion is much more accurate and precise than the media coverage. The Labour Party supports a role for the private sector in the NHS. The debate is about how large that role should be and what limits should be imposed. The motion refrains from repeating the false claim that the Government proposals would allow most hospitals to allocate 49% of beds and theatre time to private patients. The Bill clearly makes it illegal for non-NHS income to be accepted that would be expected to lead to an increase in NHS waiting times or NHS health inequalities or to a move towards putting profits before patients. However, Andy Burnham is entitled to fear that the law will be broken. The Conservative view is that the non-NHS income cap is a “belt and braces” safeguard and not something that will in practice affect many hospitals. I do not propose to cover this topic here but the true debate between the three major UK political parties is about more subtle matters than the media appear at times to recognise.