That Doctors Letter to the Telegraph


As public health doctors and specialists, we are concerned about the Health and Social Care Bill. The Bill will do irreparable harm to the NHS, to individual patients and to society as a whole.

It ushers in a degree of marketisation and commercialisation that will fragment patient care; aggravate risks to individual patient safety; erode medical ethics and trust within the health system; widen health inequalities; waste much money on attempts to regulate and manage competition; and undermine the ability of the health system to respond effectively to communicable disease outbreaks and other public health emergencies.

While we welcome the emphasis placed on establishing a closer working relationship between public health and local government, the proposed reforms will disrupt, fragment and weaken the country’s public health capabilities.

The Government claims that the reforms have the backing of the health professions. They do not. Neither do they have the public’s support. The Health and Social Care Bill will erode the NHS’s ethical and cooperative foundations and will not deliver efficiency, quality, fairness or choice. We ask the House of Lords to reject passage of the Health and Social Care Bill.

The important words here are \”public health\”. They\’re all \”public health\” professionals, the signatories. Public health being:

Public health is \”the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals\” (1920, C.E.A. Winslow).

Now, don\’t get me wrong, public health has almost certainly done more for the lifestyle and lifespan of the average human being than any other area of human endeavour. Vaccines, sewage treatment (taking \”public health\” to be widely drawn), the basic study and control of epidemics and pandemics has done more for us all that any amount of surgery or, indeed, pretty much anything else with the possible exception of abundant food for all.

However, the profession has gone on to other things:

Since the 1980s, the growing field of population health has broadened the focus of public health from individual behaviors and risk factors to population-level issues such as inequality, poverty, and education. Modern public health is often concerned with addressing determinants of health across a population. There is a recognition that our health is affected by many factors including where we live, genetics, our income, our educational status and our social relationships – these are known as \”social determinants of health.\” A social gradient in health runs through society, with those that are poorest generally suffering the worst health. However even those in the middle classes will generally have worse health outcomes than those of a higher social stratum.[8] The new public health seeks to address these health inequalities by advocating for population-based policies that improve health in an equitable manner.

Well, yes, so public health nowadays is simply the health care wing of the Labour Party. It\’s all inequality innit? The Spirit Level, Professor Marmot etc. And, of course, the people who cook up those studies lying about smoking bans reducing heart attack rates, about salt being a killer, who want to ban sugar from processed foods, who would ban Marmite from being advertised to children, who have caused the HP recipe to be changed, who bleat about the entirely made up \”safe drinking guidelines\”. Fake charities galore telling us all how we should live in order to make sure than no one, anywhere, can be accused of enjoying themselves.

So, the reorganisation of the NHS is going to reduce their power is it? Dig them out of their comfy niches where they can propagate their prejudices?

Bring it on say I.

36 thoughts on “That Doctors Letter to the Telegraph”

  1. An evil mob. But the “new” public health isn’t so new. This is the same mob who thought eugenics was the answer a century ago, and were only discredited due to a German gentleman with a funny moustache.

    The latest buzzword btw is “non-communicable diseases” as a euphemism for everything they want to ban, the inevitable tobacco smoking being top of the list of such “diseases”. (Number two is drinking beer, number three is eating hamburgers, number four is not voting Labour, or something).

  2. Upon reading this to my husband, he replied, “Isn’t the Labour Party the political wing of the NHS?”

  3. Duty calls. May I remind everyone that “risk factor” just means ‘positive correlate’, even though many people have been conned into thinking it means ’cause’. “Conned” by whom, you might reasonably enquire. See Tim’s post.

  4. “and undermine the ability of the health system to respond effectively to communicable disease outbreaks and other public health emergencies.”

    It’s a good little scare story, isn’t it? Communicable disease outbreak response is, however, nothing to do with the NHS. It’s done by the HPA who report to the Department of Health.

    So, I think we’re in a “follow the money” situation here. Once hospitals go private then they’ll be competing with providers that don’t pay for 5-a-day co-ordinators. The 5-a-day co-ordinators aren’t going to last.

  5. My dad isn’t a “public health” doc (ex-army medic & now retired after a long career at the tougher end of hospital Paediatrics ). I suspect he would agree with much of the content of that letter. Quite frankly, I’d love to see some of you walk into PICU and start bleating on about producer capture, comfy niches & other such received-position bullshit. It would give the intensive care lot a good laugh.

    longitudinal studies is

  6. Ah, well now you mention that your dad agrees with the letter that changes everything. In that case I no longer agree with the reforms.

  7. This is a completely remarkable piece of BS that keeps on coming back every time the leftists talks about competition

    “waste much money on attempts to regulate and manage competition”

    I thought these public-monopoly-provision-being-more-efficient-since-there-is-no-waste theories had been thoroughly de-bunked (over and over) again by the commies.

  8. Surreptitious Evil

    longitudinal studies is

    Unlikely. More probably, they “are”.

    And implicitly equating “public health” and “A&E” doesn’t really strengthen your argument.

  9. Ah, well now you mention that your dad agrees with the letter that changes everything.

    My point being that opposition to these reforms is as likely to come from any variety of medic – to which the standard retort on here is “la la producer interest”. No attempt is ever made to address the concerns raised by those at the sharp end – and why bother? I mean, public health is one big bansturbation employment scheme, right? And the rising incidence of cirrhosis in younger patients is just the invention of nurses anxious to enlarge the powers of the State. And all doctors leave early to hit the golf course. Etc ad nauseum.

  10. Lost_nurse:

    I think that doctors that do not want to be brushed aside as merely pushing producer interest need to start out with real arguments and/or proposals for improvement of the NHS instead of Malthusian / Marxist rants in defense of the status quo

  11. “I mean, public health is one big bansturbation employment scheme, right?”

    Yep, that about sums it up. And where it doesn’t involve banning, it involves punitive taxation. I am not interested in what those at the sharp end have to say about how other people lead their lives.

  12. equating “public heath” and “A+E”

    Are you seriously suggesting that senior public health and senior A+E types don’t share similar views on a whole bunch of stuff?


    Any citation of longitudinal studies is unlikely – given that it is easier to pretend that public health is all about fiddling with the recipe for HP Sauce.

    Emil: I’m not disgreeing, except to say that such political terminology doesn’t really serve the debate – would concentrating acute care provision in one place (as is the trend) be “Marxist”? Besides, none of this removes from the fact that the ConDem reforms are a total clusterfeck.

  13. Concentrating ACUTE care would very likely not be Marxist but then again that is not really the only thing the NHS is concentrating now is it?

    The NHS is a fucked up system so it needs to be changed. Any change is likely to be met by massive contempt from the insiders but it does need to change.

  14. it does need to change.

    No disagreement here… but not in a way that has potential to make provision worse, or screws with things that are – currently – done well.

    I’m not interested

    Jolly good.

    (The NHS is not holding you back from a life of wild freedom on some new frontier – FFS, grow up.)

  15. “The NHS is not holding you back from a life of wild freedom on some new frontier”

    Stop being silly. Parts of it are often campaigning for things that people like to do to either be banned or made more expensive. Whether these are things I personally indulge in is neither here nor there. Like Martin Niemöller, I care when it happens to other people, not just myself.

    ” – FFS, grow up.)”

    No need to be a dick about it. Disagreeing with you does not amount to immaturity.

  16. Lots of nurses, like teachers have confused the ultimate purpose of their jobs.

    The purpose of a job is not to provide employment.
    The purpose of a job is to provide a product or service .
    The decision about how this is best achieved should come from the end-user, not the worker.

    If nurses, doctors and teachers are so concerned for their patients/pupils then why are they so resistant to all change (that doesn’t involve them being paid more money)?

    Imagine a thought experiment. Tomorrow a cheap pill makes all diseases of old age disappear. Great. But hundreds of thousands of NHS workers jobs are devoted to servicing the diseases of the old. What would the reaction of nurses and their unions to the redundancies that would follow? What work, what overmanning of other depts would be demanded to keep NHS in employment? It would all be described as ‘cuts” of course.

  17. No need to be a dick about it. Disagreeing with you does not amount to immaturity.

    Ok, fine… but this: “I am not interested in what those at the sharp end have to say about how other people lead their lives” can easily be taken the wrong way – it smacks of a total refusal to engage.

  18. Hurried italics fail, apologies.

    Tomorrow a cheap pill makes all diseases of old age disappear.

    Let’s stick to the facts, eh?

  19. But when it comes to other peoples opinions on how I should lead my life, I will refuse to engage. How much I eat, drink, and smoke is not something that I will engage a discussion with. (I actually gave up smoking last year yippee! but the point remains).

    That isn’t to say I refuse to engage in all discussion with those at the front end; just that discussion that centres around banning things, or increasing tax on them. (Particularly as in the case of smoking some want to both tax heavily AND curtail treatment)

  20. not a something that I will engage a discussion with

    Indeed, that would also be my stance. And I’d go spare if anybody tried to increase the pint of my pint in an attempt to modify the behaviour of other people. But it doesn’t change my views on the (long & short term) carnage wreaked by alcohol. Moderation in everything!

    I have to run, so I can’t argue with stuck-record – except to say that (given the demographic issues), I wish he/she had picked a different hypothetical example…

  21. lost_nurse: ‘data’ is not the plural of ‘anecdote’. My mother was an SRN, a Captain in QARANC, and a senior Health Visitor. She thinks the NHS is a shambles and all but irreparable in its current form. We can play Top Trumps healthcare professionals all day, but the fact remains, producer capture is rife and so anything that emanates from the public medical sphere should be viewed with a great deal of suspicion.

  22. lost_nurse: I’m sure your father is wonderful but I work at the “sharper end” of cardiac surgery and intensive care and I think this letter and the mindset from which it emanates are awful. There is public health, and there is private health. Big macs and alcohol are private health. If a grown man wants to eat, drink, be merry or inject crack cocaine into his eyeballs, I may be revolted but it’s not my life and they are not my decisions to make.

  23. I may be revolted but it’s not my life and they are not my decisions to make.

    Indeed, and nor (within professional limits) would I be judgemental about such things at the coalface – whatever the presentation or history. I’m not trying to invade anybody’s privacy, but it’s frankly ludicrous not to join the dots between public health and what brings ever-younger punters into A+E, liver/hep and all the rest. We are being overrun – and it boils my piss when people pretend that it’s simply a matter of personal liberty versus the minions of the State. The irony being that insurance companies can be even more high-minded than the most overbearing of public health types. So, either way…

    Top Trumps healthcare professionals

    Belive me, I see the dysfunction every day – what concerns me is the possibility of yet more dysfunction. We are crating up the WWII generation on under-resourced, under-staffed elderly care wards – and handing over (other) profitable services to the usual suspects isn’t going to improve their lot, is it? It’s not like we are investing like the French, or having sensible conversations like the Dutch. The political bullshit is at an all-time high (even by NuLav standards) – and it makes me fcuking angry. Not least when I hear witless DoH missives about ‘freeing-up’ nurses, even as things deteriorate on the shopfloor.


    Because elderly care is a major challenge – perhaps the challenge – for western healthcare. There ain’t ever going to be a magic pill for old age and physical dependence – no unions will ever be campaigning for care assistants to be retained in other (supposedly gravy train) roles. Telemedicine would have been a better (if still dubious, imo) hypothetical example.

    Right, I’d love to stay and argue – but I have to go & do an afternoon stint in the funhouse.

  24. lost_nurse

    Thanks. I’ve a lot of sympathy for your position, just not the methodology suggested. I too despair of the epidemic of fat, stupid, lazy, drugged-up and pissed morons who burden our health service and society. I don’t however think they are victims, and I don’t think they are open to the persuasion/coercion of the Public Health lobby.

    They are, however, a minority, and the Public health lobby want to change everyone’s behaviour.

    This is not acceptable, and will not be effective.

    We banned guns but somehow criminals still have guns.

    We banned hard drugs but somehow criminals still have hard drugs.

    We banned burglary and rape and assault and murder but somehow criminals still have burglary and rape and assault and murder.

    And my other point still stands: Until the end-user makes the decisions about public sector services there will be no change. Turkeys do not vote for Xmas.

    The major misunderstanding about the way the world works from the ‘compassionate’ left is that just because they think of themselves as ‘nice’ and wanting to help people doesn’t mean they are right.

  25. @ stuck record: True, we have banned burglary and rape and assault and murder, and true, they still happen. Are you then suggesting that because these laws are not 100% effectual they should be rescinded, and burglary and rape and assult and murder should not be banned?

    @Tim: I scarcely know how to begin (Anyway, I thought we’d dealt with HP Sauce – this was a decision by Heinz, which elsewhere you laud for effective brand management – and the market will let us know whether their decision was appropriate. Given that some years ago Heinz took similar action in re-adjusting their recipe for baked beans with no ill-effect on sales, I’m prepared to enter into a small wager that sales of HP sauce will remain equally unaffected).

    As a general point, though, I think it must be remembered that medicine, like economics, is a pseudo-science – that is, that control experiments are impossible because real-world situations cannot be replicated. The best we can do is to use the available data to provide a rationale. So, yes, there is no scientific evidence that excess consumption of salt “causes” heart attacks. But we do know that high salt consumption is associated with high blood pressure, and that high blood pressure is associated with cardio-vascular events. So even though specific evidence is mixed, and even though there is no proof of causation, there is a strong supporting rationale for a broad-based advice to the UK population to try and reduce their salt intake if they want to try and avoid heart problems.

    I do not myself think that this is sufficient justification for banning any foodstuffs, but I do believe that consumers should have ready access to information about the content of the foods they buy, and that what is says on the packet should be what’s in the packet. However, you do seem to be strongly opposed to this approach. Marmalade, anyone?

  26. Churm.

    Err. No.
    Murder (and other crime) is prevented by punitive moral and physical penalties. These penalties only apply to those who actually commit or plan to commit murder. Last time I looked we don’t arrest and imprison everybody in society because a few people murder. This is quite an old and widespread principle.

    Public health policy, on the other hand, as discussed and promoted above, is for everybody – including sensible, non-destructive or addicted members of society – to be punished because some other feckless minority have no moral self-control.

    Quite different.

  27. A bit late to add a comment to this subject – but never mind.

    Churm said:

    “”…there is a strong supporting rationale for a broad-based advice to the UK population to try and reduce their salt intake if they want to try and avoid heart problems.””

    It it not true that within that sentence lies the serious problem that uncontrolled epidemiology has created?

    The sentence should read:

    “”…there is a strong supporting rationale for a broad-based advice to the UK population to try and reduce their EXCESS salt intake if they want to try and avoid heart problems.””

    Taking into consideration that the body excretes excess salt, only those people who continuously exceed their bodies ability to excrete excess salt are likely to suffer – and even those people might not.

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