Ever since the coalition government introduced its Health and Social Care Bill, it has been obvious that what was planned was nothing less than the destruction of the NHS as a universal healthcare provider, and the gradual privatisation of the service, leading to greater profits for private companies and, simultaneously, cuts to services.
Understanding this, the professional bodies representing those who actually work in the NHS have opposed the bill. Amongst other bodies, the British Medical Association, the Royal College of Nursing and the Royal College of Midwives have opposed the government’s plans, and last week, in an editorial published simultaneously in the British Medical Journal, the Health Service Journal and Nursing Times, the editors of those magazines described the government’s plans as a “damaging … unholy mess,” and stated that the NHS “is far too important to be left at the mercy of ideological and incompetent intervention” and that “we must make sure that nothing like this ever happens again.”
In a second British Medical Journal editorial last week, Kieran Walshe, professor of health policy at Manchester Business School, explained how abandoning the bill now would save over £1bn in 2013. As he explained, “Going ahead with the bill means setting up the NHS Commissioning Board (with an annual running cost of £492m), 260 clinical commissioning groups (with an annual running cost of £1.25bn), and the new economic regulator, Monitor (with its anticipated annual running cost of £82m). Each of these new statutory organisations will have additional set-up costs — perhaps amounting to a one-off spend of £360m. If the bill were stopped now, it would save all those set-up costs, and at least £650m in annual running costs — just over £1bn in 2013.”
On Wednesday, a group of 365 GPs, specialists and health academics urged the government to drop bill, which, they said in a letter in the Daily Telegraph, will “derail and fragment” the NHS. As the Guardian described it, the letter urged the government to “drop the bill altogether and focus instead on the ‘real issues,’ namely improving safety, efficiency and the quality of patient care.”
The letter stated that the clinical commissioning group leaders who have backed the bill “do not represent the majority of GPs who believe the bill will seriously damage patient care,” and the signatories added, “The NHS is not in peril if these reforms don’t go ahead. On the contrary, it is the bill which threatens to derail and fragment the NHS into a collection of competing private providers. The bill will result in hundreds of different organisations pulling against each other, leading to fragmentation, chaos and damage to the quality and availability of patient care.”
Also last week, the Royal College of General Practitioners, which represents 44,000 GPs in England, and the Chartered Society of Physiotherapy, which has over 50,000 members, called for the bill to be withdrawn.
Dr. Helena Johnson, the chair of the Chartered Society of Physiotherapy, said, “Together with many other health professionals, we have tried to engage constructively and make sensible suggestions throughout the bill’s passage through Parliament. But time and time again, the views of patients and health professionals have been ignored. The government seems determined to press ahead with these reforms.”
The most damaging criticism, however, came from the GPs, because, as the BBC noted, the BMA and the nurses’ and midwives’ organisations are unions, and their complaints allowed a deeply cynical government “to suggest they were motivated by the dispute over pay and pensions, whereas the RCGP is part of the professional arm of the health service which sets standards.” The GPs’ criticism is also hugely significant, of course, “because GPs are widely thought of as one of the main beneficiaries of the reforms, as they are supposed to get more control over how NHS funds are spent.” In fact, that is putting it mildly, as GPs are supposed to take over NHS commissioning with a budget of £60 bn, even though the details of how this is supposed to happen have not been explained.
As a resident of Oxfordshire, Bernard Dod, explained in a letter to the Guardian last week, although the government claims that GPs will play a key role, “Oxfordshire has 83 GP practices comprising hundreds of individual doctors. When I asked representatives of the current (soon to be abolished) primary care trust how in practice all these doctors would be able to make so many important decisions, they said that nobody knew: the new system has not been trialled. The government has embarked on a massive, destructive and expensive reorganisation without knowing how it will work, and without producing a shred of evidence that it will result in a better, fairer and cheaper service.”
Perhaps some GPs are also aware that power is only being handed over to them so that they will, in turn, hand it on to private providers. Or, as Ben Goldacre tweeted:
- In case u don’t understand NHS bill: GPs know they’re being set up to fail by being given commissioning powers. Those are specialist skills.
- After GPs fail, private commissioning expertise will be needed: large private corps, which will come to operate like health insurers.
- These large bodies, like public/private insurance co’s, will be able to pick & choose patients. Note no geographical responsibility in bill.
- Small differences will emerge in what services they offer. Top up plans will become available. And that, kids, will be that.
- It is so very obvious that GPs are being set up to fail at the specialist task of health service planning that it’s clearly not an accident.
In an attempt to fend off further criticism last week — from the GPs, in particular — the ever desperate, but ever obstinate health minister Andrew Lansley offered further concessions, including a promise that the health minister would retain the ultimate responsibility for the NHS. When this abdication of responsibility first became obvious last year, it caused understandable alarm, because it revealed explicitly how the government was seeking to make the NHS unaccountable to either voters or the government — or, in other words, how it was in fact planning to privatise the NHS.
In response to these concessions and others resulting from criticism by the Lords, including what the BBC described as “strengthening the requirement of the regulator to ensure the different providers competing for patients also work together to provide seamless services for patients,” RCGP chairman Dr. Clare Gerada said:
This decision was not taken lightly, but it is clear that the College has been left with no alternative. We have taken every opportunity to negotiate changes for the good of our patients and for the continued stability of the NHS, yet while the Government has claimed that it has made widespread concessions, our view is that the amendments have created greater confusion. We remain unconvinced that the Bill will improve the care and services we provide to our patients.
Our position has not changed, and the concerns we expressed when this Bill was at the White Paper stage 18 months ago have still not been satisfactorily addressed. Competition, and the opening up our of health service to any qualified providers will lead not only to fragmentation of care, but also potentially to a ‘two tier’ system with access to care defined by a patient’s ability to pay.
We support a greater role for GPs in the planning, design and delivery of services within their local communities, but as the organisation representing the views of over 44,000 GPs, we cannot support a Bill that will damage the care and services that GPs deliver to patients and ultimately bring about the demise of a unified, national health service.
Our view is that what is required now is to rapidly consolidate the current organisational structure, such that PCT clusters remain, with GPs placed as the majority of the Board so that we may address the serious issues facing our NHS. There should be a debate as a matter of urgency to determine what the NHS can provide, how it should be funded, and how we deal with the major health and social care problems facing our population.
In a key passage, Dr. Gerada explained:
We cannot sit back. Instead, we must once again raise our concerns in the hope that the Prime Minister will halt this damaging, unnecessary and expensive reorganisation which, in our view, risks leaving the poorest and most vulnerable in society to bear the brunt.
In conclusion, she stated:
We will continue to do everything we can, both as a College and in partnership with our colleagues in the Academy of Royal Colleges, our nursing colleagues and across the wider health and social care sectors, to bring about change for the good of our patients and preserve the principles of the NHS that has served millions of patients so well for over 60 years — a universal healthcare service, free at the point of need.
Dr. Gerada also spoke to the BBC, telling the Radio 4 Today programme that the bill would “turn the National Health Service into thousands of different health services, all competing for the same patients, the same knee, the same brain, the same heart. Patients will find their care will be fragmented, it will be on different sites, it won’t join up, it will be difficult to hand over care and it will be phenomenally expensive to keep track of all these competing parts of the NHS.”
Next week, this wretched bill will return to the Lords, where it can expect more damaging criticism, but don’t be fooled: the government still doesn’t want to give up on its dreadful plans. To keep up pressure on the government, please sign the 38 Degrees petition (which is currently very close to 500,000 signatures), and the Keep Our NHS Public e-petition on the government’s website (which is currently close to 50,000 signatures).