US and British health specialists support the NHS

http://www.theguardian.com/politics/2015/may/03/us-and-british-health-specialists-support-the-nhs

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The British National Health Service has long been admired around the world for providing health care for all citizens, in a manner that regards each life as equally precious. Your system of universal healthcare allows citizens to access medical care when needed, free of charge, funded by taxes paid by all. It is based on improving the health and wellness of all. The health security enabled by your system is but a dream for many Americans.

As American health care professionals who often use the example of the NHS to advocate for a fairer and better system in the US, we have recognised recent developments in England that are deserving of concern. In particular, we express concern over movements toward transferring more and more services to for-profit corporations in your healthcare system and measures that encourage the development of a self-pay market for care. Access to treatment should not depend on whether someone can spare the money. While some may say the changes in England have so far only been at the margins, it is the risk of a slippery slope that should cause concern.

In the US over recent decades, we have lived the challenges of a multi-tiered, for-profit healthcare system. Wealthier citizens can afford the best care. At the same time, in the same society, other citizens struggle to pay for care, sometimes choosing between food or medicine. Many rely on the emergency room for routine care. Many suffer the consequences of doing without healthcare. It is harder to maintain support for a public system when the wealthy rely on paying for better access to care.

There are many things the US healthcare system has to admire, such as our pioneering integrated care organisations and our world-leading medical research and high-tech rescue care. At the same time, the US is in the midst of a major healthcare reform effort that aims to bring affordability and equity to American healthcare. We caution the UK against moving in the direction of a system that has created the inequality in US that we are now working to repair. Your universal, public healthcare system is an example to the world, and something of which Britain should be proud. We urge you to preserve it. Dora Wang MD PhysicianArthur Lavin MD Pediatrician and facultyDonald Nguyen Pediatric urologistLisa Marlowe PsyD Clinical psychologist Cyndi Fowler Nurse executiveRyan Q Simon MD Consultant physicianScott Tyson PhysicianRebecca Jones MD PhysicianKatherine Lambes MD Internal medicine/pediatricsLisa Vantrease MD Family physicianChristopher M Hughes MD PhysicianRichard Bruno MD Resident physician, family & preventive medicineRichard Waters MD Primary care physicianKatherine Scheirman MD MHA US Air Force colonel (retired)Scott Nass MD MPA family physicianDavid Sanders MD PhysicianElizabeth Wiley MD JD MPH resident physicianMichael Kaplan MD Family physician and associate medical directorAndrea DeSantis DO Family physicianMargaret Flowers MD Co-directorGarrett Adams MD MPH past president, Physicians for a National Health ProgramDon R McCanne MD Senior health policy fellowMorris Brown MD National Medical Association Chairman, Family Medicine Natalie Spicyn MD MHS primary care physicianXaviour Walker MD DTM&H hospitalist and general preventive medicine residentMark Ryan MD FAAFP Assistant professor, department of family medicine and population healthDanielle Alexander MD PhysicianCecile Rose MD MPH Professor of medicineKyle Bohan MPH DO PhysicianJames P Scott MD Past president, National Physicians AllianceChristopher Brown MD MPH Chief resident, internal medicine William B Jordan MD MPH PhysicianLi-hsia Wang MD FAAP General pediatricianKristin Huntoon Resident physician Alap Shah MD Professor of Family MedicineStephen Marsh MD Family medicine residentKevin Burns MD Family physicianHenry L Abrons MD MPH Pulmonary and critical care, retiredShelly Choo MD MPH Resident physicianIrmina Sultana Haq MD MPH Resident physicianWalter Tsou MD MPH Past president, American Public Health AssociationGene Bishop Clinical asociate professorMax Romano Johns Hopkins University School of MedicineTim Lachman MD Associate professor of clinical neurologyAdam Law MBBS MSc MD FRCP Attending physician in endocrinologyCarla Campbell MD MS Associate teaching professorEsther K Chung MD Professor of pediatricsF. Stuart Leeds MS MD Assistant professor of family medicine Gary L LeRoy MD Family physicianJames Plumb MD MPH Professor of family and community medicine

• As senior public health professionals, we must draw attention to the damage that the coalition government’s policies have done to the health of the British people. First, it placed “responsibility deals” with producers of junk food and alcohol at the centre of its public-health strategy. As its own evaluation confirms, these have achieved almost nothing. Second, it has delayed action on issues such as reducing the salt hidden in food, which researchers have linked to 6,000 additional deaths.

Third, it has failed to implement minimum unit pricing for alcohol, again in the face of research evidence that this would save thousands of lives. Fourth, its austerity policies can be linked to a reversal in the long-term downward trend in suicides, which have increased most where welfare cuts have been most severe. These policies have also contributed directly to a marked increase in food poverty, with growing numbers dependent on food banks. Fifth, it has failed to address the already poor health of British children. The areas where the government has made progress, such as standardised packaging for cigarettes and antimicrobial resistance, show what could have been done.

This reluctance to act, whether due to ideology, closeness to corporate interests or fears of being accused of “nanny-state tactics”, has been damaging to health and has led to many thousands of unnecessary deaths. Whatever government is elected this week, we call upon it to put evidence before ideology. The people’s health must come first. Professor Martin McKee CBE Professor of European Public Health, LondonProfessor Simon Capewell Professor of Clinical Epidemiology, LiverpoolProfessor John Acres Professor of Public Health, SouthamptonProfessor Sheila Adam CBE Former Deputy Chief Medical Officer, England, LondonDr Sushma Acquilla Former Academic Registrar, Faculty of Public Health, NorthallertonDr Tim Anstiss Founder: Academy for Health CoachingMs Pam Ashton Public health community advisor, MerseysideProf Sue Atkinson CBE PH Consultant & Former Regional DPH, LondonProfessor Gus Baker Professor of Clinical Neuropsychology, LiverpoolProfessor Clare Bambra Professor of Public Health Geography, DurhamDr Ben Barr Senior Clinical Lecturer in Applied Public Health Research, LiverpoolProfessor Yoav Ben-Shlomo Professor of Clinical Epidemiology, BristolProfessor Richard Bentall Professor of Clinical Psychology, LiverpoolProfessor Susan Bewley Professor of Complex Obstetrics, LondonDr Chris Birt Honorary Research Fellow, LiverpoolProfessor Carol Brayne Professor of Epidemiology, CambridgeProfessor Nicky Britten Professor of Applied Health Care Research, ExeterDr Catherine Brogan Public Health Chief Executive, LondonProfessor Eric Brunner Professor of Social and Biological Epidemiology, LondonDr Andrew Burnett Former Director Of Public Health, LondonProfessor Francesco Cappuccio Professor of Cardiovascular Medicine & Epidemiology, WarwickProfessor Martin Caraher Professor of Food and Health Policy, LondonProfessor Sir Iain Chalmers Co-founder Cochrane Collaboration OxfordDr Kailash Chand OBE General practitioner Tameside & GlossopDr Elaine Church Consultant Obstetrician and GynaecologistProfessor Aileen Clarke Professor of Public Health& Health Services Research WarwickProfessor Jeff Collin Professor of Global Health Policy EdinburghProfessor Anthony Costello Professor of Global Health, LondonDr Jack Czauderna Former GP, SheffieldProfessor Linda de Caestecker Honorary professor at the University of Glasgow, GlasgowProfessor Carol Dezateux CBE Professor of Paediatric Epidemiology, LondonProfessor Peter Diggle Distinguished University Professor of Epidemiology and Statistics, LancasterGina Dowding County Councillor LancashireProfessor Elizabeth Dowler Professor in Food & Social Policy, Warwick Professor Christopher Dowrick Professor of Primary Medical Care, LiverpoolDr Maria Duggan Director, LondonProfessor Shah Ebrahim Professor of Epidemiology, LondonDr Etheline Enoch Ebola Clinical Lead, LondonProfessor Matt Field Professor of Psychology, LiverpoolProfessor John Gabbay Former Professor of Public Health, SouthamptonProfessor Mark Gabbay Professor of Primary Care, LiverpoolProfessor Amandine Garde Head of Law Department, LiverpoolDr Katy Gardner Senior Partner, LondonDr Clare Gerada MBE General Practitioner, LondonProfessor Ruth Gilbert Professor of Clinical Epidemiology, LondonProfessor Anna Gilmore Professor of Public Health, BathProfessor Mark Gilthorpe Professor of Statistics, LeedsProfessor David Gunnell Professor of Epidemiology, BristolProfessor Sir Andy Haines Professor of Public Health & Primary Care, LondonProfessor Gerard Hastings OBE Professor of Social Marketing, StirlingDr Fengjun He Senior Research Fellow, LondonProfessor Susan Higham Professor of Oral Biology, LiverpoolDr Alison Hill Consultant in Public Health, OxfordDr Judith Hooper Retired Director of Public Health, Kirklees Professor David Hunter Professor of Health Policy and Management, DurhamProfessor Bobbie Jacobson OBE Former Director, London Health Observatory, LondonProfessor Ann Jacoby Professor of Medical Sociology LiverpoolProfessor Philip James CBE Honorary Professor of Nutrition, LondonDr Tony Jewell Former Chief Medical Officer, Wales CardiffProfessor Lynne Kennedy Head of Department of Clinical Sciences & Nutrition, ChesterProfessor Kay-Tee Khaw CBE Professor of Clinical Gerontology, CambridgeProfessor Tim Lang Professor of Food Policy LondonProfessor David Lawrence Honorary Senior Lecturer in Health Services Research, LondonProfessor Andree Le May Co-editor, Journal of Research in Nursing, SouthamptonProfessor Alastair Leyland Professor of Statistics, GlasgowProfessor Stuart Logan Cerebra, Professor of Paediatric Epidemiology ExeterProfessor Graham MacGregor Professor of Cardiovascular Medicine LondonProfessor Rajan Madhok Retired NHS director of public health and medical director NHS ManchesterProfessor Barrie Margetts Professor of Nutrition, SouthamptonProfessor Alan Maryon-Davis Former President, Faculty of Public Health, LondonDr David McCoy Reader in Public Health, LondonProfessor Stewart Mercer Professor of Primary Care Research, GlasgowProfessor John Middleton Independent Public Health Consultant, CoventryDr Clive Needle Policy & Advocacy Director, LondonProfessor Kate O’Donnell Professor of Primary Care Research & Development, GlasgowProfessor Eileen O’Keefe Emeritus Professor of Public Health, LondonDr Steven Oliver Senior Lecturer, YorkDr David Pencheon OBE Director, NorwichProfessor Kate Pickett Professor of Epidemiology, YorkProfessor Jennie Popay Professor of Sociology and Public Health, LancasterDr Dan Pope Senior Lecturer in Public Health, LiverpoolProfessor Geof Rayner Honorary Research Fellow, LondonDr John Robson Reader in Primary Care & Tower Hamlets/ GP, London Professor Ted Schrecker Professor of Global Health Policy, DurhamProfessor Alex Scott-Samuel Honorary Professor, LiverpoolProfessor Alwyn Smith CBE Emeritus professor of epidemiology, ManchesterProfessor David Stuckler Professor of Medical Sociology, OxfordDr Qutub Syed Former Regional Director of Public Health, ManchesterDr David Taylor-Robinson Senior Lecturer in Public Health, LiverpoolDr Arpana Verma Senior Lecturer & Honorary Consultant in Public Health, ManchesterProfessor Ian Watt Professor of Primary Care, YorkDr Jane Wells Consultant in Public Health, OxfordProfessor Margaret Whitehead WH Duncan Chair of Public Health, LiverpoolProfessor Ewan Wilkinson Professor of Global Public Health, ChesterProfessor Graham Winyard CBE Former Deputy Chief Medical Officer, WinchesterDr Katrina Wyatt Associate Professor of Health Research, Exeter• The crisis in nursing is just one sign of malaise in the NHS. The loss of qualified nurses (community nurse numbers alone have been cut by over 3,300) means that the NHS relies on costly agency staff or overseas nurses (recruited at the cost of £5,000 each). Too few nurse training places have been commissioned because saving money trumps workforce planning. Putting things right requires more than extra funding: money is being wasted on privatisation.

The NHS is now a market in which private companies compete to provide services – especially since the Health and Social Care Act 2012, which itself cost £3bn to implement. This market may be costing the NHS more than £10bn a year; tendering for one contract can cost £1.5m of public money. Private providers have to put profits before patient care. 

For nurses, the current NHS business ethos of wanting more for less exhausts us, stresses our managers, robs us of their support and leadership, encourages bullying, silences whistleblowers and holds down pay. The crisis in nursing requires an end to privatisation, possible with support for the NHS (Reinstatement) bill. There are 680,000 registered nurses: if parliamentary candidates want our vote, they should think carefully about how they treat our NHS.Professor Helen Allan Professor of NursingProfessor Fiona Ross CBEProfessor Jane Salvage Nursing consultantProfessor Di Marks-Moran Honorary professor, NursingLiz Meerabeau Professor of Healthcare, retiredPam Smith Professorial fellowSusan Osborne CBE Director of nursing and safe staffingGillian Black District nurse, former director of nursingDr Loretta Bellman Consultant, nursing and healthcareDr Jan Savage Nurse researcherLucy November Midwife and public health practitionerZeba Arif RCN Forensic Nursing ForumRebecca Newman Hospice nurseAnita Weston Sexual health nurseVal Thurtle Health visitor lecturerAngela Tod Clinical nursing researcherIrena Chojnacka Professional lead, adult nursingLinda Burke Higher educationJennifer Kempinski Palliative care nurseClaire Honey Health visitorNina Heaps Health visitorGwen Vardigans RCN North Yorks Branch secretaryPaula Denham Clinical nurse specialist, palliative careAisling Donnelly Health visitorBerit Moback Project manager, end of life careClare O’Riordan Profession development lead, health visiting and school nursingAnna Edge Health visitorJennifer Walker Nurse practitioner, general practiceMike Travis Children’s nurse, RCN council memberAndrea Jennings District nurse (community nursing)Stella Backhouse Nurse bloggerChristina Sosseh Community learning disability nurseKaren Taylor District nurse team leader, Queen’s nurse, community practice teacherGay Lee Palliative care nurseLaurance Druiff Senior nurse, HIV and sexual heathCaroline Smith District nurseGillian Meldrum MidwifeAbbey Eboigbe Sexual health nurse adviser/HIV nurseJill Highet Retired palliative care specialist nurseShazeda Begum District nursing, CommunityShirley Ali Anaesthetic nurseGill Todd RMN (psychiatry)Karen Sanders Intensive care nursing/nurse educationTeresa Loy Private sectorCarlos Forni Locum community psychiatric nurseMichael Martin Cardiothoracic nurseChristina Clark Community psychiatric nurseNicky Parry Education/RGN/end of life careCarey Johnson Haematology registered general nurseLaura Clark Community psychiatric nurseAlison Mansfield Ward sister, palliative care – hospiceSharon Carter Diabetes specialist nurseTrudi James Health visitorVicky Sorel-Cameron Palliative careVeronica Killen Senior lecturer

• Professor Chris Ham and Nigel Edwards (Letters, 29 April) make important points about NHS funding. But the political parties are also largely missing the opportunity to talk about what they will do to improve patient safety in the NHS. This is a fundamental point and one that should not be ignored in the general election campaign. Tens of thousands of unregulated health professionals continue to perform investigations, tests and procedures on patients.

This is despite their work coming with considerable risks to patients. The consequence is that they are not subject to any kind of fitness to practice tests, nor the previous government’s “duty of candour”. It is difficult to identify errors or incompetent practitioners, and harder still to drum them out of the health service. The political parties have a responsibility to talk about how they will fund the NHS in the future. They also have a duty to explain how they will keep patients safe. And this must involve the statutory regulation of such professionals.Amanda CaseyChair, Registration Council for Clinical Physiologists