25 Nov, 11 | by BMJ Group
This NHS Health and Social Care bill is radically different to any health legislation since the inception of the NHS. It removes the health secretary’s duty to provide or secure the provision of universal healthcare to the general population, and puts in place the legal framework for a commercial system in which the NHS is reduced to the role of paymaster to multiple willing providers.
It is designed to privatise the NHS at all levels: primary care, secondary care, in community health services, and in commissioning – all of it concealed behind the publically trusted NHS logo. The reforms will increase the stake of private companies in the NHS, so that instead of GP led primary care and consultant delivered hospital services we will witness “any willing providers” picking up the most lucrative operations, with the NHS left to provide complex, costly care.
A market based competitive spirit will ensure that only the fittest survive. The bill allows the corporate sector such as “The Practice PLC” and “Chilvers McCrea Healthcare,” to take over the running of general practice. The proposed relaxation of traditional GP practice boundaries will further attract supermarkets giants like Tesco and Asda. The strategy will be to employ salaried doctors to cater for generally healthy mobile young patients, while traditional practices are left to cope with the burgeoning elderly population with long-term conditions.
We agree overwhelmingly with the BMA’s warning that the new draft guidance from the Department of Health – Developing Commissioning, would give large commercial companies in-built advantage into new commissioning structures. These proposals would position commissioning support in a full-scale market and introduce commercially focused criteria to determine who is eligible to provide this support. The CCGs will become silent spectators in watching full blooded privatisation of the NHS.
Vitally, the health secretary will no longer be able to intervene as he would have abdicated from responsibility to oversee the provision of universal health care. The destruction of the NHS will be engraved on the coalition’s political gravestone and it will have a significant adverse effect on future generations.
The prime minister repeatedly telling us that the reforms are well supported by the royal colleges and health workers would not stand to scrutiny. The BMA has openly asked the bill to be withdrawn, the Royal College of Nursing has passed a vote of no confidence in Andrew Lansley, a large number of scholars have written openly in the national papers for the bill to be withdrawn, and notable Liberals such as Baroness Shirley Williams and Dr Evan Harris have come out in opposition. It is worth reminding ourselves that there is no mandate from the public or either party in the coalition to this reform.
Key to Lansley’s reforms (dubbed Dr Lansley’s Monster by the BMJ) is economic efficiency and a target of £20bn to be achieved by 2015. This is an impossible target to achieve, for many reasons. Even during the sternest times, the NHS has been expected to run a cost efficiency reduction of 4% despite the evidence that only 2% was achieved at the most. Against a competing demand of more expensive treatments and high patient expectations it is just not possible to improve financial efficiency to the extent the coalition government proposes without it seriously affecting patient care.
The projected cost of the reorganisation is £3bn, which is money that is drawn away from frontline provision of care. You don’t have to be a rocket scientist to answer the simple question: “Is this Bill necessary, given the current state of the UK economy?” A further concern is that commissioning as proposed has never been tried and tested elsewhere. The coalition intends to make GPs responsible for all commissioning other than that of specialist services.
The flaw in this argument is that GPs are not experienced in commissioning, many do not want to do it, and also it will take those very experienced GPs who do take the role, away from providing patient care. These GPs are likely to be at a level of seniority where they are a major asset to patient care. Drawing them away from patient care is likely to have consequences for primary care.
For those who intend to commission and have the resources to do so, it seems less than clear how any conflict of interest will be overcome. Those who commission will be permitted to provide a service too, effectively increasing the scope of self-commissioning and self-profit.
The most contentious part of the Bill is the Secretary of State’s intentions to introduce private health care well beyond the vision of any previous government. There is already scope for foundation trusts to increase their income from private providers, but so far they have been cautious not to do this as they still operate under the framework of the NHS Constitution.
Removing the barriers will mean that waiting lists will target patients with higher resources than the NHS tariff, private patients will be prioritised over NHS patients, and the real threat is that the elderly and the vulnerable, those with chronic mental health problems, those with chronic medical problems such as diabetics, renal patients, etc will be a low priority.
There is every possibility that the reformed NHS under these proposals will become exclusive rather than inclusive. Removal of a cap over private income will see foundation trusts competing over costs rather than quality, so that those that are run by poor management will risk the stability of the hospital to a much greater extent than prevails now.
This is the wrong reform at the wrong time. There are many in the health services who share our views, and for all of these loyal NHS workers there is one single motive – that is, to keep the NHS as a publicly funded service, for the good of the people, and not one that is only there for those with the means to access care or for those who can benefit financially from the ill of others. These reforms will pave the way for substantial privatisation of the NHS, and it will set us apart from other health services in the UK – in Wales, Scotland and Ireland. ‘National’ will go out of the NHS.
Please sign the petition, it will be impossible to reverse the damaging changes it threatens to impose, thus sealing the fate of the NHS. The e-petition will take no more than 60 seconds, but 60 seconds could prove invaluable to avoiding the destruction of the National Health Service.
You can view the e-petition at: http://epetitions.direct.gov.uk/petitions/22670
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.