Kailash Chand: No confidence in Andrew Lansley

Kailash ChandWith the Royal College of Nursing’s (RCN) no confidence vote in Andrew Lansley, it is generally accepted that it is no longer possible to have a rational debate on the reforms while Andrew Lansley is health secretary. He did not listen during the gestation time of the white paper for the proposed Bill on the NHS in England. Four weeks ago,  a motion of no confidence in him was narrowly defeated at the BMA’s special representative meeting, and this week the nurses passed a definitive vote of  “no confidence” in him.   The bill has also been widely criticised by scholars, patient groups, and even the Health Select Committee Chairman, Stephen Dorrell. The BMJ has dubbed it Dr Lansley’s Monster; the King’s Fund makes clear its own view on how competition will adversely affect the NHS, and the BMA passed a clear motion at its special representatives’ meeting asking for the bill to be withdrawn.

Andrew Lansley keeps parroting the usual guff about GP support for his reforms. This claim is totally untrue. Surveys by royal colleges and Pulse magazine have proved time and again that less than one third GPs think the reforms will improve healthcare. The reality is that GPs are professionals and do not wish to create a void that patient care will fall into and suffer, so yes, they sign up, usually passively for pathfinder status. And they will work hard to continue improving patient care; but please don’t politicise their commitment to their patients for ideological purposes.

The Cameron/Clegg/Lansley’s listening exercise seems to be about selling their plans better, rather than any desire to change them. Lansley, even when he apologised to nurses, kept insisting, it is all about communication, not substance. By and large the profession supports clinical engagement and integrated commissioning . What the profession and BMA is objecting to is the marketisation of the NHS, as passionately and consistently as they opposed the private sector encroachments of “New Labour.”

I am not against change in the NHS. Indeed, the NHS needs change to we meet the challenges of financial austerity, the burden of the growing population, the cost of drugs, and the growing advances in medicine. During our working life in the NHS we have seen multiple reforms, some good and some not quite so good. This one is plainly ridiculous. The NHS is a cherished institution, where young and old, privileged and impoverished, the very sick, and the worried  are all treated without discrimination. Any reform has to recognise these strengths, and more.

But what the Health and Social Care Bill contains is the blueprint to marketise the NHS, producing a postcode lottery where profit for stakeholders will surely trump the cost of utilising all available resources for patients. The proposed reforms risk fragmenting patient care, removing accountability, and distracting GPs from providing quality care to their patients as they become besieged with the complexities of commissioning. The threat of extinction for some hospitals will become a reality, as private institutions cream off the lucrative bits.

The legal imperatives may add a further dimension to this troubled bill, where the coffin seems to be gradually camouflaged under the weight of the nails.

What price the bill?

It is hard to see how the Health and  Social Care Bill can be salvaged. Sticking with the bill and therefore Lansley seems a risky option, particularly agiven his woeful handling and inability to listen. Public and professional bodies would have better faith in dealing with someone who has not just the ability to listen but also to steer away from radical changes in the NHS.

Kailash Chand has been a GP for last 30 years and is now chair of the NHS Trust Tameside & Glossop. He was on the BMA council and general practitioner’s committee until last year. He was awarded an OBE in 2010 for services to the NHS. He writes for the Guardian, and other regional and national publications on health matters.

  • Drsatyasharma

    Kailash has written an interesting article with reasoning.
    Nurses may have excluded themselves form key positions if any were to be offered by voting yes to no confidence motion with a substantial majority,however,the strength of feeling is there for everyone to see!
    Everyone knows that by voting in favour of such a motion,no health secretary will be or has been sacked.This argument was enough to dissuade many doctors attending SRM of BMA last month.

  • Dr kumar kotegaonkar

    Dr Chand
    has made a very strong case against dangers of marketisation of the NHS.RCN voted 99% in no confidence motion.BMA SRM was very wisely advised by Chairman Dr Hamish Meldrum prior to vote not to make it a personalise issue, principles in the Health BIll were voted out in all debates.BMA represents patients interests as well as professions and did not wished to close the door,which spared the Health Secretary from the no confidence vote.It is absolutely essential the government take notice of the anxiety and reservations medical profession has regarding the changes and the speed.Considering the opposition from academics,carers,Parlimentary committee and even Politicians in the coalition,let this pause pull them back from any hasty changes.
    Time to ressure NHS is safe in Mr Camerons hands.

  • Ashok Atrey

    . Status quo is not an option for NHS and Reforms are essential but the timings and lack of consultation with people who matter most is not helpful. First group of stake holders are patients, then general public of England and then all type of clinicians and it does not appear their collective views have been considered.

    Changing people at the helm is not an answer but influencing their views is important..

    As Secretary of State for Health, PM and deputy PM have said there needs to be a pause and consultation and then proceed with what is consensus opinion.

  • Naresh Bhardwaj

    I have read Dr Chands article with interest & applaud him for writing this because he is part of N H S as we know it. Mr Lansley seems to be hell bent on destroying a good running institution.Dr Chand is right when he says NHS needs some cost cutting because of the present general financial crunch but definitely not the wholesale destruction of it by carrying out these so called “reforms”. It appears either Mr Lansley is ignorant about the concept of NHS or there are some hidden motives ie handing it over to the private sector. In both the cases he is a danger to NHS and he should go.
    DR NK Bhardwaj

  • Louise Irvine

    This shows that the nurses have more balls than the doctors!!

    Good for them!!

    I disagree that voting no confidence excludes them from influence. It depends on the situation. In this case the vote of no confidence is added to a wave of criticism and opposition so that it may be part of something that tips the balance and forces the government to change the bill substantially or withdraw it. Remember this is a collation of two parties, neither of which managed to get a majority, and which is already showing serious cracks over the NHS. It is not the same as when Thatcher's government was pushing through reforms that the BMA opposed and found itself sidelined by so doing. We are now in very different times politically and with a bill that is seriously wrong-headed and unpopular. In this situation a vote of no confidence is absolutely right – and I wish the BMA had done the same.