Liberal Democrat Parliamentary Candidate for Bracknell, Patrick Smith, has today released an open letter to Conservative incumbent Dr Phillip Lee challenging him to come clean with voters on his positions regarding the future of the NHS.
During a live radio debate for BBC Radio Berkshire last week Dr Lee denied having ever suggested that patients might be charged to see their GP, despite comments printed on his own website which appear to suggest just that. When confronted with his own words Dr Lee accussed the Liberal Democrats of spreading lies about him and became physically aggressive toward the Lib Dem candidate.
Patrick comments, “It was quite rattling really. You go into these debates expecting it to get passionate, but Dr Lee’s behaviour overstepped the mark and was completely unbecoming of the office he hopes to be re-elected for. After the debate one of the other candidates commented that they were worried he was close to throwing a punch at me.”
In the open letter Patrick challenges Dr Lee to come clean with voters about comments he has made on the NHS, stating, “voters have a right to understand clearly and unambiguously where you stand on this matter.” Patrick challenges Dr Lee to debate with him publicly, head to head, on the future of the NHS before the general election on May.
The full open letter is copied below:
Open letter to Dr Phillip Lee, Conservative Parliamentary Candidate
Dear Dr Lee,
Last week on BBC Radio Berkshire you and I had quite a heated debate, both on and off air, about the future of the NHS and some of the statements you have made about it. What was probably not entirely obvious to listeners on the radio was how your behaviour during this disagreement was physically aggressive and quite unbecoming of public office. At one point you actually stole my notes from my hand, crumpled them into a ball and threw them at me. One of the other candidates later commented that they were worried you might even throw a punch at me – I’m sure you would never do such thing, but you should be aware how your behaviour in a public place came across to others.
In this debate I (and also UKIP candidate Richard Thomas) referred to comments you have made which appear to suggest that you endorse charging some patients for basic NHS services, including but not limited to visits to see their GP. You denied ever making such comments and accused myself and the Liberal Democrats of spreading lies about you. We therefore both made quite serious accusations about one another that we should justify.
I am writing this letter as an opportunity for us both to clear the air and make that justification.
In 1946 the people of Britain did something incredible and unprecedented; we decided collectively that as a nation we would take responsibility and care for one another in times of sickness or injury. In a progressive and unrivalled display of grace and compassion we established the National Health Service, publicly funded through taxation, to deliver healthcare to every citizen free at the point of need. As a nation we decided that never again would a person’s financial situation be permitted to have an impact on the quality of healthcare they were entitled to receive – regardless of economic status, every person among us should be given a right to the same universal standards of healthcare, and we would all pay for it together. We understood that this would be expensive; we accepted that some people would pay far more into the system than they ever got out, whilst others would receive significantly more care throughout the course of their lives than they ever personally paid for; we even acknowledged that there would inevitably be those who abused this system, but we agreed to do it anyway because that was and will always be the right thing to do.
On a number of occasions as MP for Bracknell you have made public certain opinions regarding the future of the NHS which I and many Bracknell constituents find deeply concerning. You rightly point to looming concerns about the long term challenges in funding the health service which I acknowledge and do not shy away from. You call for a broad and wide ranging debate on these challenges, and I commend you for voicing that issue at a time when many others would prefer to ignore it. However, you also go further, and have made comments which clearly indicate not just the need for such a debate but also your personal position on the answers to it.
In November 2012 you made comments, which were widely reported in the media, suggesting that patients suffering from what you determine to be “lifestyle diseases” should have to pay for treatment at cost. You particularly singled out sufferers of type 2 diabetes, commenting rather condescendingly that, “people who eat doughnuts for breakfast,” needed to, “match actions to consequences”[1,2,3] This understandably incurred significant backlash from the diabetic community who were quick to point out that there are a plethora of risk factors that are associated with this form of diabetes, many of which are outside of personal control such as environmental factors and genetic predisposition.[4,5] In reference to this “lifestyle disease” you very specifically advocated charging patients for their treatment, commenting, “I would suggest one way of perhaps trying to move that locus of responsibility for health care from the state to the individual would be in making it that you pay for your drugs at cost.”
I am very concerned about your judgement of “lifestyle diseases”. Of course there are choices we all make everyday regarding what we eat, how much exercise we take and other routine behaviours which can form one of many factors contributing to a range of illnesses and injuries, but it is rarely possible to draw a direct causal link between an individual’s day to day choices and a life threatening ailment. If we are going to begin branding conditions as “lifestyle diseases” where do we start drawing lines? At what BMI does diabetes shift from being a consequence of lifestyle to being the unfortunate result of other factors? And why just diabetes – if we are going to head down that route do we start charging patients with heart or lung conditions because they have struggled with addiction to cigarettes? Do we charge the skin cancer patient who spent more than a predetermined number of hours in the sun? Do we charge the person hit by a car because they made a momentary lapse of judgement before stepping out into the road? This is a dangerous and slippery slope.
Since 2012 you appear to have developed this line of thinking further. I refer specifically to comments made in an article posted on your website in February of this year, an abridged version of which was printed in the Sunday Express. These were not spur of the moment, poorly expressed comments for which you might be given some leeway in interpretation, they echo comments made previously and you have clearly had time to measure and weigh your words carefully.
I quote the entire offending paragraph from your recent article, taking care that I am not misrepresenting your words or simply taking a small snippet out of context:
“Other countries offer a range of payment options we should test. Norway charges patients to see their GP and for routine tests. Germany has a compulsory social insurance scheme. France uses a means test. In Denmark patients are charged (at cost) for their drugs once a modest annual budget has been spent; only the terminally ill are excluded.”
Your language here is quite specific. You do not simply say that these are options “we should discuss” or “we should include in the debate”, but specifically state that they are things “we should test.” That is an explicitly pro-active choice of language that implies implementing these measures, at least on a trial basis, within the NHS. Of course, if you are open to testing them, even on a small scale, that also suggests that you are open to deploying them more widely.
It is further worth noting that the very first example you give is that “Norway charges patients to see their GP.” You don’t make a statement of that magnitude by accident – you chose to say it and you meant what you said, now you must face up to the electoral repercussions of those comments and be honest with voters about the changes you hope to bring to the NHS.
I am a reasonable man, I’m not in the habit of misrepresenting people or spreading false allegations, so I want to give you the opportunity to explain these comments. Perhaps you are somehow able to demonstrate that I am misreading the article quoted above and it doesn’t say what I and a great number of concerned constituents read it as saying – in which case I will willingly apologise to you and publicly retract my comments. Perhaps it does say what I think it says, but what it says is not really what you meant and you have simply expressed your positions poorly on this matter – in which case I invite you to publicly clarify these comments and we can all put this matter to bed. Perhaps you meant exactly what you said at the time, but have now reconsidered your position – in which case I suggest you declare this publicly, apologise to those constituents you have offended (particularly those suffering from type 2 diabetes), and retract your accusation that I have been spreading lies about your historical position – we all have the right to change our minds and if this is the case I promise to handle your about turn graciously and will respect you for admitting to it. Or perhaps it says exactly what I think it says, that this is exactly what you meant and this continues to be your position – in which case I request that you retract your denial, made on the radio last week, and face up to the electorate about where you really stand.
Voters have a right to understand clearly and unambiguously where you stand on this matter. Protecting the NHS, including the central principles that it is publicly funded and free at the point of service, is an issue I have received a huge volume of correspondence on from constituents. I have publicly committed to protecting those principles; there is no NHS without them. Various constituents I have communicated with on this matter advise that they have not received a response from your office to their enquiries. It is time you came clean and answered the simple question constituents are putting to you – will you commit to protecting an NHS that is always free at the point of use?
Off air last week you suggested to me that I was being irresponsible and ignorant of the long term challenges facing the NHS. You implied, as you have done in print, that your positions here are in some way above the fray of politics; as if to suggest that anyone who disagrees with you can only possibly be doing so for party political point scoring rather than out of concern for the NHS. I assure you that is not the case and find your implications here to be extremely arrogant – you ask for a debate, but simultaneously preclude any contribution from anyone who dares to disagree with you. That’s called fundamentalism and there is no role for it in a liberal democracy.
We should be clear; your position is entirely political, it has nothing to do with the sustainability of healthcare and is founded upon your base political assumptions regarding the role of the state and an agenda for lower taxes for the rich. You are no more above the politics than anybody else and you should admit that and stop pretending.
The measures you suggest would do nothing to reduce the per capita cost of healthcare provision in the UK, in fact evidence from around the world suggests they would make healthcare more expensive. Research by the Commonwealth Fund and cited by the BMA shows that the UK has among the lowest per capita healthcare costs of any developed nation (beaten in their 2014 study of 11 leading nations only by New Zealand), and ranked the UK as first for both efficiency and overall performance.[8,9] Public funding of the health service is critical to that success, cutting out middlemen such as insurance companies that exist only to extract a profit from health provision without doing anything to add value. The report specifically cites universal health provision as a significant factor consistent among the top performing nations.
The only difference the changes you advocate would deliver would be to who foots the bill. Rather than us all paying through taxation, those most in need would foot a larger portion of the bill at the point of use. This would specifically function to redistribute payments and place a significantly larger burden of the costs on the shoulders of the poorest and most vulnerable in our society. I can only conclude that this is a plain and simple case of old school class warfare – an affluent Conservative expressing disgruntlement that your taxes fund the healthcare of the poor. You may not like it, but that is what we do in a fair and just society and I am proud of it.
I’m sure that you will disagree with me on these points, as you did quite aggressively last week. You have called for a debate on this matter; I agree, so let’s do it. I challenge you to debate with me, publicly, head to head over the NHS before the general election on May 7th.
I look forward to hearing from you to arrange this.
Liberal Democrat Parliamentary Candidate for Bracknell