Betraying the NHS: Health Abandoned

Michael Mandelstam has a legal background and has been involved in health and social care issues and with disability for many years. He describes a health service undermined by government targets, financial incompetence and reconfiguration, citing his experience in Suffolk and elsewhere in England. He exemplifies services being lost or at risk - in one chapter he lists over 60 hospitals at risk in March 2006...He refers to the various ways the government is opening the NHS to the market with resultant uncertainty, negative effects on finances and competition between providers. He describes the dangerous introduction of 'Payment by Results', a system which by means of financial and performance targets puts in question treatment based on clinical need.

The author concludes that these initiatives impinge most on vulnerable people and create anger, fear and protest throughout communities. Mandelstam has a style of writing that is all his own, quirky and even apocalyptic. He does not produce all the answers to providing the NHS we all need but sets out the issues supported by evidence that need to be resolved before its too late.

Nursing is a political profession and a huge element of the wider health picture, which this book illustrates well. I definitely recommend this book; it was a treat to read, but a very sobering one.'

'This would be a perfect book to give, for instance, to a foreign visitor or 'non-health relative' who wanted to understand what has been happening to the NHS in recent years and what it has felt like for patients, staff and citizens. Mandelstam sustains an informed, articulate and smouldering sense of justified outrage, mainly about authorities overriding expressions of local needs particularly of the most vulnerable...

the author delivers a damning verdict on the mismanagement of the NHS nationally, regionally and locally. Mandelstam describes lucidly how changes in the NHS were driven by concealed agendas, including privatisation, and resulted in damaging decisions which adversely affected many people and particularly older people with chronic and complex needs, people with physical or learning disabilities and people with mental health problems. He also pays due attention to the almost total lack of democracy and accountability nationally and locally... Mandelstam tackles a lot - and well. Not least, he is outstandingly readable.

Government plans to transform the NHS by stealth will lead to further crucial accident and emergency services being lost. That's the message from author Michael Mandelstam, a former Department of Health official who this week publishes a controversial, wide-ranging study into the future of the NHS.

Mandelstam said the closure of accident and emergency (A&E) services, which campaigners have already been fighting in Monklands hospital in Airdrie, is a 'knee jerk' reaction to the financial mismanagement of the NHS. He said other A&E wards will close in the future... They're closing [A&E services] because the government, in England and Scotland, has mismanaged all the extra investment that's gone in and they suddenly realise they've spent huge amounts of money hitting targets, '.

The book is a searing condemnation of Tony Blair's handling of the NHS at national, regional and local level. It exposes how NHS trusts and primary care trusts are being bullied by central government into meeting flawed and rushed clinical and financial targets.

It details how these targets ensured that the fundamental NHS principle of care based on need has been superseded by the principle of care based on numbers; how managers are tempted to fiddle figures and make adjustments as they panic under pressure and fear for their jobs; and how local people are being forced to pay for any managerial incompetence as individual trusts are made responsible for their own finances and forced to live within their means .

As Mandelstam says: The Government seemed to be concerned less with patients losing services and more about those NHS Trusts and PCTS that had failed to make sufficiently drastic cuts.

This book is an impressive indictment of the changes made recently by the Government to the National Health Service. The damage these changes have inflicted on the people of Suffolk, especially the elderly and other vulnerable people, is documented in damning and relentless detail. Sadly Suffolk isn't the only place where promises are being broken, the principles of the NHS abandoned, the needs of communities ignored and financial targets ruthlessly pursued regardless of the consequences.

Michael Mandelstam's analysis is unanswerable and his criticisms robust. His book should be studied by everyone concerned with how health care is delivered in Britain. If any of the politicians, civil servants or administrators who devised or implemented these changes have the nerve to read it they should hang their heads in shame and resign at once.

The author has been generous in the book about the contributions other people, including myself, have made to fighting these changes and exposing their consequences. The truth is that the person who has done the most in this respect is Michael Mandelstam himself. His tireless work, persistence in the face of all kinds of bureaucratic and other obstructions and his considerable expert knowledge of 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.