Betraying the NHS

Mandelstam's evaluation is incisive and an indictment of management in healthcare… This book should be relevant to all concerned with the future funding and provision of healthcare in the UK - just about everyone who pays taxes.

A useful reference for those current illustrations of the state of the NHS

It's a spirited, engaging and intelligent book and deserves wider publicity and readership.

Michael Mandelstam is well respected within occupational therapy circles for his expert legal analysis and effective communication style, and was a keynote speaker at last year's College of Occupational Therapists' conference. In this thoroughly researched, authoritative and timely book, he carefully constructs his argument that the Government is dismantling and fragmenting the National Health Service (NHS) through stealth, without a democratic mandate, by means of calling in debts that had been tolerated until after the last election…This book should be read by anyone who wishes to understand the devastating consequences of what is happening now to health and social care. It serves as a timely reminder to the occupational therapy profession to stand up for the principles of public service in support of its core values.

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.

The book's pity title hints at the sharp writing style that continues throughout this chunky tome. The gardening and harvesting metaphors for section headings and the intensely political subject matter indicated a treat of a read ahead.

Spanning the years 2004 to 2006, Mandelstam describes the betrayal felt by members of Suffolk community as they prepare to fight a local primary care trust over planned cuts and closure of services, including two local hospitals. The lack of accountability on the part of the NHS and central government is portrayed here as a microcosm and the residents (a.k.a the national population) are depicted as living in the land of free speech, but with speech falling on deaf ears.

Highlighted is the dynamic basis on which the government must operate if it is to be effective in managing the NHS and how this tough necessity is unfortunately experienced at the point where services are to be delivered. To demonstrate sensitivity for all parties, from central government to an elderly, vulnerable casualty, whose relatives believe died because local services were unavailable due to cuts and closures, is a gargantuan task and one Mandelstam has ably achieved.

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,"'.

This is an extraordinary book, written by an extraordinary person. The energy and commitment required to research and record this micro-history of health and social care in Suffolk is truly astonishing, and stems from an entirely justifiable sense of outrage. This is communicated in a measured and well-reasoned way, with every assertion supported by documented fact. …This book stands as a fascinating, if deeply depressing, statement. It also sounds a warning 'choice', 'modernisation' and 'reform' conceal a privatisation agenda which is being carried out with haste and deceit.

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.

Michael Mandelstam has vividly illustrated and authenticated his grand theme – the warranted collapse of public trust in NHS Trusts – by a blow-by-blow account of hospital closures, in Suffolk particularly. In the course of it he tells of public consultations of shameless insincerity and of almost Orwellian "mantras, euphemism, and doublethink". Above all, his is a cautionary tale of our times – of ideological centralisation out of touch with local realities.

BETRAYING THE NHS is extensively researched and referenced. It documents the bewilderment of local people and their sense of powerlessness in the face of centrally imposed changes and ever moning goal posts. This book is destined to become a classic text for those seeking to understand health care policy and its effects on the lives of local people.