Yesterday, the British Medical Association (BMA), the union that represents 140,000 doctors and medical students in the UK and worldwide, dealt a major blow to the coalition government’s plans for the biggest overhaul of the NHS since its foundation in 1948 by voting to tell the health minister Andrew Lansley to “call a halt to the proposed top down reorganisation of the NHS” and to “withdraw the Health and Social Care Bill” that he presented to the House of Commons in January. The meeting, attended by 400 representatives of doctors’ groups from around the country, also specifically condemned Lansley’s plans as “too extreme and too rushed,” and complained that they “will negatively impact on patient care.”
Widely regarded as ideologically driven, unnecessary, ill-conceived and chaotic, and as a vehicle for the privatization by stealth of the NHS, Lansley’s bill proposes “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.”
Hamish Meldrum, the chair of the BMA, said that Lansley’s plans “could have ‘irreversible consequences’ on the organisation and on patient care,” as the Guardian explained. Although Meldrum “acknowledged that involving doctors more in decision-making” and providing more information for patients was a good idea, he specifically pointed out that, “on so many occasions, it’s the reality not the rhetoric that counts and it’s the reality that is causing all the problems.”
In carefully chosen words that will be hard for the government to dismiss, he also described the bill — and the pace of change pushed for by the government — as follows:
What we have is an often contradictory set of proposals, driven by ideology rather than evidence, enshrined in ill-thought-through legislation and implemented in a rush during a major economic downturn.
The BMA’s vote (which was enormously important, as I explained in a previous article, Save the NHS! Will the BMA Do the Right Thing, and Reject the Coalition Government’s Privatization Bill?) follows another defeat for the government at the Liberal Democrats’ spring conference in Sheffield at the weekend, where a grassroots rebellion, “fuelled by fear of privatization and an undue emphasis on competition,” as the Guardian put it, and led by Shirley Williams and former MP and doctor Evan Harris, saw party members vote almost unanimously to “give councillors a central role in GP commissioning and in scrutinising foundation trusts.” Members also called for “a ban on all cherry-picking by private companies offering treatment services.”
The Lib Dems’ complaints certainly addressed some of the problems with Lansley’s bill, but the only way to address all of them is to follow the lead of the BMA, and to call for the entire wretched project to be scrapped. Few people, I’m sure, would deny that savings need to be and can be made within the NHS, as with all aspects of government spending, but unlike other areas — university funding, for example, where the main complaint is that tripling fees and withdrawing 100 percent funding from the arts, humanities and social sciences is too much of a change, over too short a time, which risks endangering the viablity of the entire university sector — the complete restructuring of the NHS has no rational basis, as the NHS is widely regarded as working well after Labour’s years of substantial investment. Even so, Hamish Meldrum identified several areas in which persistent problems remain — as he explained in his report prior to the meeting — although as he also pointed out, “Even if we were successful in preventing the whole Health and Social Care Bill being passed — which would be no mean, and probably, unachievable feat — these massive challenges will still remain.”
Despite the BMA’s vote, and that of the Liberal Democrats, Downing Street responded to the criticism by describing the BMA’s emergency meeting as “unrepresentative of the BMA membership,” adding that it was “disappointed it had decided to oppose reforms it had previously supported.” This was particularly insulting to Hamish Meldrum, as it attempted to play down his role as chair of the BMA — and hence his powerful criticism — whilst also ignoring the fact that the representatives present were speaking and voting on behalf of the wider membership.
The criticism also ignored the fact that the BMA’s “previous support” of the reforms actually consisted of a policy of “critical engagement” with the health minister, seeking “to amend key aspects of the bill while not opposing its central tenets,” and that this failed not because of the BMA, but because, as Dr. Kevin O’Kane, chairman of the BMA’s London region, said at the weekend:
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.
For his part, Lansley has insisted that he will “only be making minor changes” to the language of the bill in response to the Liberal Democrats’ vote on Saturday. He has yet to respond directly to the BMA, but it now seems probable, as the Guardian explained, that either “some influential cabinet figures,” who are also dissatisfied with the progress of the bill, will have to persuade the minister “to recast a bill that is losing support daily,” or the bill will be savaged at its report stage in Parliament, “where the medical profession is a strong lobby and could rip the bill apart,” especially because the vote in Sheffield “will free previously loyal Lib Dem MPs to voice opposition inside the parliamentary party.”
Should either of these approaches fail, those of us who care about the NHS — and do not want American-style privatization to take place under the watch of a minister who exemplifies the arrogance and the malignant ideology of this government — will have to take to the streets to keep Nye Bevan’s dream of universal healthcare alive. If Lansley wants a fight, then I for one am up for it. Care to join me?