Speaking on the Today programme yesterday the Prime Minister claimed to be committed to what he called our ‘precious’ NHS. He said he wanted it to go on succeeding, free at the point of use. But unless he is still not paying attention to what is in Lansley’s Bill (which is possible, as Cameron often seems curiously indifferent to the detail of his government’s policies) he is being completely disingenuous.
The crucial point is this: the Bill relieves the Health Secretary of his existing responsibility for providing a universal and comprehensive health service, and doesn’t allocate it to anyone else. It leaves it up to unaccountable local GPs grouped in Consortia to decide what services their particular patients will be entitled to, and what they will have to pay for, and how much, and this can vary from one consortium to another – goodbye both comprehensiveness and universality. It leaves an unaccountable healthcare market regulator (Monitor) to decide what private companies can offer NHS patients, and whether they can underbid NHS hospitals on price, and it mandates Monitor to promote competition – goodbye free care at the point of delivery.
The whole thrust of the Bill is to create a competitive market with a large expansion of provision by companies focussed on shareholder value. To pretend otherwise is, frankly, to insult the public’s intelligence. And it doesn’t make it any better to declare, as Cameron did, that because the population is ageing, the NHS ‘has to change’. That sort of rhetoric has lost all traction with the growing number of people who have woken up to what is going on. Change is constantly necessary in all services. The question is how handing over the NHS to market forces is supposed to improve it. The evidence points decisively against competition in health care and by now everyone knows it.
In March the BMA came very close to declaring outright opposition to the Bill. The nurses at their Liverpool conference in April repudiated the Bill and Lansley with it – by a majority of 478 to six. Unison and Unite are massively opposed. Cameron now says he would like ‘more full-throated support’ from the NHS workforce. Even his capacity for spin is getting seriously overstretched.
The name of the game for Cameron and Lansley now is to appear to be making ‘substantive changes’ to the Bill which will in fact leave its aims intact. The patently deceptive Future Forum ‘listening’ exercise with its Panel of five, chaired by a notoriously pro-market GP, plus 40 handpicked medics and managers, is designed to give a fig-leaf of legitimacy to what will actually be a behind-the-scenes search for amendments that look major but are not. These will not include the ‘essential amendments’ proposed by the Lib Dem rank and file after the Sheffield conference; those amendments are incompatible with the aims of the Bill and Lansley will not be accepting them. Whether the Lib Dems will tolerate yet another abandonment of their principles remains to be seen.
The task for everyone who is genuinely committed to the principles of the NHS is to ensure that the true aim of the Bill is kept clearly in view, and to insist that the media don’t collude in the lazy sort of misrepresentation that Cameron is hoping to get away with.