With 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affect the NHS, and the BMA passed a clear motion at its special representatives’ meeting asking for the bill to be withdrawn.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.