As NHS doctors we have been closely following the exchange between Stephen Hawking and the secretary of state for health over the past week (Why won’t Jeremy Hunt come clean?, 26 August). Since Professor Hawking delivered a momentous speech to the Royal Society of Medicine exposing the policy-driven reality of NHS underfunding and moves towards a US-style insurance system, tensions have mounted.

The profound irony of Jeremy Hunt claiming that a world-renowned professor, an academic pioneer who has dedicated his life to generating scientific evidence, is spreading “pernicious falsehoods”, or that his appraisals are “misguided”, when Jeremy Hunt himself has been unreservedly criticised for misuse of evidence for political expediency, is not lost on us. In fact, so audacious a claim is this that we have asked ourselves what could have prompted such a zealous response?

As the NHS crumbles around us, with scores of A&Es and maternity units being downgraded or closed via implementation of “STPs” (Sustainability and Transformation Plans), as patients wait months for outpatient clinics, operations and cancer treatments, with junior doctors leaving in droves and nurses desperately covering 40,000 unmanned posts, all the while the private sector flourishes and takes up swathes of once-NHS contracts, it is clear Hunt will do absolutely everything possible to distract the public from the politically motivated destabilisation of the NHS. His baseless promise of a “seven-day NHS” has masked underlying motivations behind contract and service changes now exposed to make NHS staff less valued, and allow routine profitable services to be increasingly outsourced.

Professor Stephen Hawking has spoken more truth in one week than has been said in five years of the secretary of state for health’s term.



Prof Allyson Pollock Director of Institute of Health and Society, Newcastle University

Dr Bob Gill GP, Producer, The Great NHS Heist documentary

Mr Chidi Ejimofo Consultant in emergency medicine

Dr Louise Irvine GP, Lewisham, Health Campaigns Together co-chair, London

Dr Tony O’Sullivan Retired paediatrician, Co-chair of Keep Our NHS Public

Dr Aislinn Macklin-Doherty Oncology trainee, Health Campaigns Together

Dr David Wrigley GP, chair of Doctors in Unite

Dr Rachel Clarke Palliative care doctor, Oxford

Dr Nadia Masood Anaesthetic registrar, London

Dr Jacky Davis BMA Council

Mr Chris Efthymiou Consultant cardiothoracic surgeon, Leicester



Dr Unmesh Bandyopadhyay CT2 Medicine, Kent, Surrey & Sussex

Dr James Haddock CT2 in anaesthesia, West Midlands

Dr Youssef El-Gingihy GP, London

Dr Amit Sud Clinical research fellow, London

Dr Lauren Gavaghan Consultant psychiatrist

Dr James Chan ST3 Doctor in emergency medicine, Leeds

Dr Taryn Youngstein Speciality registrar, rheumatology, London

Dr Robert Adams Urology CT2, Essex

Dr Coral Jones GP, Hackney

Dr Bernadette Borgstein Consultant paediatric audiovestibular physician

Dr Dominic Pimenta BSc (Hons) MBBS MRCP

Mr Rishi Dhir Orthopaedic surgical trainee, MRCS

Dr Ruth Wiggans ST5 in respiratory medicine

Dr Yannis Gourtsoyannis Infectious diseases trainee, London

Dr Ellen McCourt Anaesthetic trainee, north-west

Dr John Puntis Consultant paediatrician, Leeds

Dr Jackie Applebee East London GP

Dr Julia Paterson Psychiatry trainee, London

Dr Mona Ahmed Consultant psychiatrist, London

Dr Helen Groom GP Gateshead

Dr Pete Campbell Trainee doctor, north-west

Dr Lois Paton GP

Miss Stella Vig RCS Council, consultant surgeon

Dr Jon Dale Retired occupational physician

Dr Jan Macfarlane Retired GP

Dr Emily Whitehouse ST7 paediatric doctor

Dr David Church GP, mid-Wales

Dr Luke Foster CT2 anaesthetics

Dr Anna Livingstone GP, London

Dr Kambiz Boomla GP and lecturer, east London

Dr Ashling Liillis Paediatric trainee

Dr Hugo Farne Specialist registrar and clinical research fellow in respiratory medicine, London

Dr Ron Singer Retired GP and vice-president of Doctors in Unite

Dr Ellie Bard Obstetrics and gynaecology trainee, London

Dr Natasha Haringman ST1 obstetrics and gynaecology

Dr Amanda Owen Psychiatrist

Dr David Kynaston GP, Yorkshire

Dr Gary Marlowe Chair BMA London Regional Council

Dr Amy Squire Psychiatrist, MBChB MRCPsych

Dr Fionna Martin Medical registrar, London

Dr James Crane Medical registrar London

Dr Patrick French Consultant physician, London

Dr Pam Wortley Retired GP, Sunderland

Dr Paul Hobday GP, Sutton Valence, Kent

Dr Sarah Hallett Paediatric SHO, London

Dr Jonathan Fluxman GP, London

Dr Moosa Qureshi Haematology academic trainee, Cambridge

Mr Mark R Williams ENT ST5, north of England

Dr Edwina Lawson GP, London

Dr Piyush Pushkar Psychiatry CT3 doctor

Dr H Grant-Peterkin ST6 Adult/Older Adult Psychiatry

Dr Laura Davies MbChB MSc MRCS

• NHS England’s Five Year Forward View and Sustainability & Transformation Plans (STPs) involve a massive restructuring of the NHS into a public/private enterprise. Much of this is drawn from the US private health insurance-based system. It includes new systems and structures to enable the dismantling of the NHS – the sell-off of NHS land/property (via NHS Property Services), the introduction of alternative funding sources (via Joint Ventures and Special Purpose Vehicles), and the creation of radically new healthcare overseers at the heart of the enterprise called Accountable Care Organisations (ACOs), Multispecialty Community Providers (MCPs) and Primary and Acute Care Services (PACs).

ACOs, MCPs and PACs will be awarded huge contracts to manage and provide whole packages of care. When almost inevitably faced by tax funding shortages, NHS England’s plans enable them to turn to private insurers for “help”. These new organisations are US concepts. The consultants involved in drawing up the plans include McKinsey and US giant United Health subsidiary Optum which have extensive US interests.

US insurance corporation Centene’s UK subsidiary has just been subcontracted to run Nottingham’s STP as it moves to the ACO system. Centene Corporation co-owns the management company of the ACO-like “Alzira model”. The Alzira and US healthcare insurance giant Kaiser Permanente, originators of the ACO concept, have been cited by Jeremy Hunt as the models for NHS England’s ACOs.

And Hunt suggests that Professor Hawking is being “pernicious” in his concerns that we are moving towards a US-style system!

John Furse

London

• When one such as Stephen Hawking is so assertively outspoken on a political issue, any reasonable person is obligated to actively listen to what he says is happening to the NHS. What grieves me deeply is knowing that the government is hiding the fact that it is overseeing the shrinkage of the NHS – a safety-critical system – with cuts inevitably now leading to direct harm to patients.

NHS rationing and under-resourcing operate concurrently to increase demand for self-pay or insurance. Elective surgery spend on outsourcing to private sector increased 60% in the last two years. Privatisation of the NHS also comprises forms other than outsourcing, and the players and apparatus to speed this direction of travel indeed incline towards a US-style ACO system.

The government doesn’t actively have to do any more. It can now just let it happen. I’ve no doubt that the government is holding back its rescue fund for the NHS until some of the multibillion STP contracts have been tendered into private hands. Hence the urgency to develop STPs so hastily.

Hawking’s cogent warning is clear and real, beseeching public and media action to be heard and acted upon. This is not a conspiracy theory; it’s a government-facilitated downgrading and corporate takeover of your health service.

Dr Nick Mann

London

• A key question about accountable care organisations (Stephen Hawking is wrong about our NHS plans, 28 August) is whether there will be a direct relationship between publicly provided ACOs and NHS England, or whether the ACOs will be put out to tender to the likes of Virgin Care and United Healthcare. If the latter, it will bring about the complete privatisation of the NHS.

Morris Bernadt

London

• About 30 years ago Mrs Thatcher declared that the NHS was “safe in our hands” and that expression became something of a Tory mantra. However, it has not been heard for quite a while. We are now told that under the Tory party the NHS will remain “free at the point of use”. This formula is reiterated by Jeremy Hunt. In theory healthcare could be free at the point of use and provided entirely by the private sector, eg US-style Health Maintenance Organisations, or indeed Virgin Healthcare. In that scenario, control would have passed out of government hands and the NHS as most people understand it would have ceased to exist. If a private company providing a vital service said it would collapse without a substantial infusion of money it would have the government over a barrel. Private provision has now reached about 7% in the NHS, and the trend to private provision was bolstered by the Health and Social Care Act of 2012, which made it mandatory to allow “any qualified provider” to bid for NHS contracts. This specific point of increasing private provision in the NHS was raised by Stephen Hawking in his criticism of government policy and ignored by Jeremy Hunt in his responses. It is high time he addressed the issue.

Brendan O’Brien (retired GP)

London

• Has Jeremy Hunt had a Damascene conversion about the NHS? In 2005 he co-authored a pamphlet that called for the NHS to be replaced by an insurance-based system and for denationalising the provision of healthcare in Britain. So is he being honest when he says that he wants the NHS to remain a taxpayer-funded system for ever? He challenged the suggestion by Professor Hawking that the adoption by the NHS of Accountable Care Organisations (ACOs) is a step towards an insurance-based system. Such a step might not yet be clear, but the steps towards denationalising the NHS are clear. ACOs will be responsible for the great majority of health and care services within their areas under contracts let by STP commissioning groups. In time, these contracts will be open to competition by private providers. If we do not want companies like Virgin Care to be running the majority of our health services then I would hope that people like Professor Hawking will keep speaking out.

Jim Pragnell

Otford, Kent

• Jeremy Hunt uses an old politician’s bluff in saying “the health service has record funding”. Costs continually rise, so this quote is a meaningless boast. Funding increases have to be measured against both inflation and need. Perhaps the argument boils down to, who would you trust: Stephen Hawking or Jeremy Hunt?

Ian Close

Paisley, Renfrewshire

Read more letters on the NHS

• Doctors back Stephen Hawking’s challenge to Jeremy Hunt

• NHS staff feeling drained by endless reorganisation

• Labour ought to speak out about the NHS as strongly as Stephen Hawking

• When waiting for health services can have fatal consequences

• Bloody NHS didn’t even allow me time to read my mag

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