Last month the UK government released its amended regulations on NHS procurement after considerable outrage from health organisations, trade unions, and parliamentarians, over what appeared to be clear breaches of agreements. Is it a merely a cosmetic re-write of regulation 75 again that seeks merely to better disguise the true privatising aim of these regulations, or does it help to address the concerns that many had – this is the million dollar question? The legal situation is highly complex and health commentators gave different interpretations of what the revised regulations would translate to in practice.
The BMA’s General Practitioners Committee has passed a motion opposing and calling for withdrawal of the section 75 regulations, demonstrating that GPs believe these regulations will be damaging In forcing them to use competition against patients’ interests. Clare Gerada,( the chair of Royal college of General Practitioners) who too is seeking the withdrawal of 75 regulations said: “For over 60 years the NHS has done what virtually no other health system has produced – universal health care, free at point of use, delivering excellent care at a cost to the tax payer many billions less than a comparable one. This will now change as we move the resourcing , monitoring , delivery and planning for health care to the for- profit sector. Not a Big Bang but slow burn.”
Seeking withdrawal of section 75 is just not left wing scaremongering, there is plenty of evidence that market-driven health services can lead to limited choice, escalating costs, and reduced quality. And let’s remind ourselves, the biggest health market in the world, the US, has achieved the remarkable double whammy of having the most expensive system in the world and the greatest health inequalities.
We have a set of regulations that no one understands and where confusion reigns. Even the House of Lords committee responsible for scrutinizing the regulations concluded last week that there is “no common understanding” of the new rules, saying that the Department of Health has given “insufficient time” to set the system up properly and enable thorough scrutiny.
The idea that competition breeds excellence and market forces make everything more efficient is not always the case and the evidence for this in health is very limited. Two successive governments have now shown that simulating a market ethos in the NHS might bring blips of success, but it carries the potentially fatal consequence of producing erratic behaviour from otherwise sensible people.
It is time to reject the market ideology that has plagued the NHS for more than 25 years and wasted billions of pounds in the endeavour to get more of the NHS budget into the hands of private companies.
Instead, like the Scottish, the Welsh and the Canadians, we should move forward with a publicly funded, publicly provided, publicly accountable healthcare system based on co-operation, collaboration and the social contract between doctors and patients.
On 28 March the BMA united with the Royal College of Nursing to call for these controversial regulations to be amended. With the new commissioning arrangements now in force from 1 April, the lack of clarity and assurance from Ggvernment has created considerable anxiety among clinicians as they prepare for the changes. The legal framework must be crystal clear on the limits of competition.
It is clearly in everyone’s interest to ensure that commissioners are completely clear about the rules.
It will be vital to have an absolute reassurance that commissioners really will be allowed to make the best decisions about the use of competition in providing high quality services for their local populations. Commissioners must not be forced into tendering services inappropriately, wasting the NHS precious time and money.
Kailash Chand has been a GP for last 30 years. He is deputy chair of the BMA council and he was on the general practitioner’s committee. He was awarded an OBE in 2010 for services to the NHS. The views he expresses in his blog posts are entirely his own.