Save The NHS! Will The BMA Do The Right Thing?

At the heart of the coalition government’s unprecedented plans to butcher the British state — under cover of the financial crisis caused by their chums in the City – and to privatize everything that has not been privatized over the last 30 years, there is so much bad news that it is hard to keep up, let alone to organize opposition effectively. To mention just a few topics, there is university education, in which student fees are set to rise from £3290 a year to £9000 a year, and arts, humanities and social sciences courses face a 100 percent cut in funding, there is the £18 bn cut to the welfare bill, in which the poor, the poorly paid, the unemployed, the sick and the disabled are under attack, and there is the proposal to lay waste to legal aid funding, which will have a disastrous effect on the ability of ordinary people to have access to the judicial system.

Also under threat, as I discussed in a recent article, Battle for Britain: Resisting the Privatization of the NHS and the Loss of 100,000 Jobs, is the NHS, Britain’s favourite institution by a mile, despite its citizens’ persistent grumbling, which, for the most part, still does what it was set up to do over 60 years ago: look after everyone who is ill, without a penny changing hands on entry of exit from the system, and the entire mechanism operating as a giant insurance scheme for everyone, paid for through taxation.

This miracle — and if you’ve ever had a premature baby you will know what a miracle it is — is under grave threat from health secretary Andrew Lansley, whose  aim, as laid out in the government’s health and social care bill, is “to abolish all of England’s 152 primary care trusts,” and ten strategic health authorities, “which currently plan services and decide how money should be spent,” and to transfer all of these decisions to GPs, who will form consortia “which will take control of 80% of the NHS budget [£80 bn a year], buying services from providers in the public, private and charity sectors.”

As the Guardian reported on February 4, Lansley’s plans to transform the NHS in England “have united in opposition doctors, health thinktanks (and the right-of-centre thinktank Civitas), unions representing the 1.4m-strong NHS workforce, health academics, MPs on the health select committee, the NHS’s major employers, and patients’ representatives,” and this opposition has not diminished in the last five weeks, Just ten days ago, for example, Dr. Mark Porter, the chairman of the British Medical Association’s hospital consultants committee, warned that the reforms risked turning the NHS into “an increasingly tattered safety net” for those with complicated ailments (diabetes and obesity, for example), because private firms would “cherry-pick” easy patients, and could also lead to local hospitals being shut down and patients refused by private providers because their treatment would cost too much. Dr. Porter explained, in particular:

Very deliberately the government wishes to turn back the clock to the 1930s and 1940s, when there were private, charitable and co-operative providers of healthcare. But that system failed to provide comprehensive and universal service for the citizens of this country. That’s why health was nationalised. But they’re proposing to go back to the days before the NHS.

On Tuesday (March 15), there will hopefully be a decisive showdown between medical professionals and the government, leading to a climbdown on the government’s part. The trigger is a special representative meeting (SRM) — essentially an emergency general meeting — of the BMA (the trade union for 140,000 doctors in the UK) in London, where, as the Guardian reported, “Doctors are considering passing a vote of no confidence in the health secretary, Andrew Lansley, amid mounting anger over his plans to radically restructure the NHS.”

The vote of no confidence in Lansley has been submitted by the BMA’s London regional council (its biggest branch, representing 34,000 doctors), and is just one of many motions taking careful aim at Lansley’s plans. My favourite urges the BMA, as the Guardian described it, “to reject the whole of the health and social care bill,” and to drop its policy to date, which has involved “critical engagement” with the health minister, seeking “to amend key aspects of the bill while not opposing its central tenets,” even though Lansley has shown no willingness to engage with his critics.

The motion calls on the BMA “to oppose the bill in its entirety, publicise and oppose the damaging elements of the bill [and] consider what form of action should be taken by the medical profession,” and in explaining the need for concerted action to effect a complete rethink on the government’s part, Dr. Kevin O’Kane, chairman of the BMA’s London region, said:

There’s an enormous groundswell of opinion among doctors from all around the country that they lack confidence in the secretary of state for health. The SRM is not a kneejerk response to the government’s proposed legislation. The BMA has until now attempted to have dialogue with the health secretary since he released his NHS reform white paper last summer. But unfortunately Andrew Lansley has totally ignored our concerns and has behaved in a high-handed fashion with the concerns of the BMA, other health unions, the medical royal colleges, patients’ groups and health thinktanks. Mr Lansley seems determined to plough his very lonely furrow, which will inevitably lead to the breakup of our NHS. Under the circumstances I will be very surprised if we find many doctors who have confidence in his proposals or his manner of pursuing them. Doctors are disappointed and frustrated at being sidelined by the government, and deeply concerned for the future of the NHS.

Another motion, from doctors in Buckinghamshire, states that opposition to the entire bill is appropriate because Lansley has “reneged on a pre-election promise not to reorganise the NHS,” which is correct, and has also “demonstrated his desire to destroy the public’s trust in their GPs” and “pursued policies despite a lack of evidence that they will improve either patient care or the NHS’s pressurised finances.”

Another motion, put forward by doctors in Birmingham, expands on the important question of the lies told by the government during the election campaign, proposing that the BMA “would not buy a used car off someone who had trumpeted no ‘top-down’ reorganisation of the NHS prior to being elected and then proceeds to introduce a massive and clearly long-planned reorganisation of the NHS after being elected.”

Lansley is also accused of deliberately distorting the NHS’s record to further its agenda. Several motions criticise “the government’s use of misleading and inaccurate information to denigrate the NHS” and the “cynical and misleading use of statistics by Andrew Lansley and colleagues to denigrate the achievements of the NHS over recent years.” Others claim that “this wilful misrepresentation of the achievements of the NHS shows contempt for both the public and for health professionals” and accuse Lansley of “ignoring recent successes, such as record patient satisfaction levels and fewer deaths from heart attacks and cancer.” For more on this, see this excellent Guardian article by Ben Goldacre, which includes the classic lines:

[W]hen Lansley says all the evidence supports his interventions, as he has done repeatedly, he is simply wrong.His wrongness is not a matter of opinion, it is a fact, and his pretence at data-driven neutrality is not just irritating, it’s also hard to admire. There’s no need to hide behind a cloak of scientific authority, murmuring the word “evidence” into microphones. If your reforms are a matter of ideology, legacy, whim and faith, then, like many of your predecessors, you could simply say so, and leave “evidence” to people who mean it.

I leave the final word to Kailash Chand, a GP since 1983 and the chairman of Tameside and Glossop NHS, who wrote in the Guardian yesterday:

This mother of all reforms plans to further extend the healthcare market within the health service in England, fronted by GPs, herded en masse into commissioning consortiums. They will be given £80bn of public funds to buy healthcare from a system of competing providers under an “any willing provider” policy that will see private hospitals able to provide NHS care.

For professionals delivering care, the commercialisation of the health service will lead to a situation where clinical decision-making is increasingly influenced by financial considerations leading to the erosion of the social contract between doctors and patients. This is an affront to the public service ethos that glues the NHS together. The traditional role of doctors as the true advocates of patients will soon become history, just as it has in the US. […]

The BMA must grasp the nettle and unmask Lansley’s reform agenda for what it is – the final step in the privatisation of the service. No amendments are going to turn this sow’s ear into a silk purse, and the special representatives’ meeting needs to vote in favour of rejecting the bill in its entirety. This would send out the strongest possible message that the grassroots of the medical profession have understood and rejected Lansley’s ideologically driven plans.

Note: For further action, readers can visit the following websites, where there are a number of petitions and letters:

Save the NHS: A petition (hosted by 38 Degrees) telling the government, “Don’t break up our health service and hand it to private healthcare companies” and “Listen to the the real experts — doctors, nurses and patients — when they give warnings about these plans” (over 72,000 signatures so far).
Save Our NHS: A petition urging MPs to vote against the bill (over 35,000 signatures so far).
Keep Our NHS Public: A statement “call[ing] on organisations, healthcare workers, patients and the public to campaign to protect the NHS from further privatisation and fragmentation, and to keep our NHS public.”
Royal College of Nursing: A letter opposing the cuts.