The British Medical Association – representing 147,000 doctors in the UK – finally lost patience with Andrew Lansley’s unloved and unwanted Health and Social Care Bill last week when its national Council voted decisively to move to a position of full opposition to the entire Bill and to campaign against the threatened legislation.
Up until now the doctors’ trades union has believed that it could rescue the parts of the Bill that appealed to some doctors, in particular the proposal that GPs commission care on behalf of their patients. At the same time they hoped that by reasonably engaging with politicians they could mitigate the frankly obnoxious parts, in particular the burgeoning involvement of the private sector in delivering the service, and the emphasis on competition rather than collaboration in the English NHS, an attitude which is completely counter cultural for health care professionals and which has no benefit for patients beyond a spurious ‘choice’ agenda which most don’t want.
However a leaked document – Developing Commissioning Support: Towards Service Excellence – has proved to be the final straw that broke the BMA’s hope that something – anything – could be rescued from this legislation. It is written in the usual impenetrable jargon and double-speak but when translated into plain English it indicates that the private sector will rapidly be taking over the support of commissioning, leaving GPs with little power beyond organizing some specialized areas such as learning difficulties and yet still likely to get the blame for the cuts and closures which will inevitably result from the financial squeeze which the NHS is facing.
It makes a mockery of promises to put the profession and patients in the driving seat, a position which will instead be firmly occupied by the transnational health corporations who see huge opportunities for helping themselves to a large slice of the NHS budget.
With GPs furious about this early betrayal it is now difficult to find anyone outside the Coalition and the Department of Health who thinks this Bill is anything other than a dangerous and chaotic mess. More than a few Tories wish it would just go away. The Lords are trying to water it down with amendments but the Bill is of a piece, woven from whole cloth and no amendment is going to make it palatable or even workable. With Andrew Lansley arousing more suspicions by refusing to disclose the risk assessment documents to the House of Lords (so much for promises of transparency in government) it is astonishing that it is being allowed to stagger on when it would be in almost everybody’s interest to put it out of its misery.
The NHS is after all (Commonwealth Fund Study 2011) one of the most cost effective and popular health services in the industrialized world, and the last thing it needs (according to a recent report by the OECD) is another major upheaval. The ‘crisis’ of the NHS is a manufactured one, scare stories invented to suit the Coalition’s assault on public services, and we are not fooled by bogus statistics about poor outcomes, of which the government should be ashamed.
So here is a suggestion. Halt the Bill now, just stop it and concentrate on rescuing the situation on the ground brought about by starting to implement it before it is law. Then we can take a deep breath and consider in relative leisure how we can improve the NHS without destroying it. Otherwise this will be the Coalition’s poll tax, and they will suffer the political consequences because the public will not forgive the political vandals responsible for the destruction of the most popular institution in this country bar none.
Dr Jacky Davis is a consultant radiologist, co-founder of Keep Our NHS Public and a member of the BMA council. She has written this piece in a personal capacity.