Open letter to the medical profession: Now is the time to get tough on NHS reform

We are writing as a group of concerned doctors and we are also members of UK BMA Council.

Next week the representatives of UK doctors meet in Cardiff for the annual BMA meeting. The meeting occurs at a time when the NHS is at a crossroads. ??The 60-page Government response to the Future Forum does nothing to reassure us about the Health and Social Care Bill and its underlying aim to impose a fully-fledged market on the NHS, which will result in increasing fragmentation and privatisation of the English NHS.

It has become very clear that on close inspection of the Government’s response to the NHS Future Forum report, the key changes that the BMA and other organisations like the RCGP have asked for have not been met:

1. That the Secretary of State should retain responsibility for ensuring provision of a comprehensive health service.

A technical briefing note on the Government response by the Public Interest lawyer Peter Roderick and Dr Evan Harris concluded that “it appears that the new Bill will continue to propose abolition of the Secretary of State’s duty to provide health services in accordance with the Act, and of his or her duty to provide the key listed NHS services, and will not propose to give this duty to any other body”

2. That Monitor’s primary role to promote competition should be removed.

Although the regulator, Monitor, will no longer “promote” competition “as an end in itself”, the government says that it “will maintain the existing competition rules for the NHS” and give it a “clearer statutory underpinning” which implies that there will be at least the same, or more competition, and not less. The government will do this by making the Department of Health‘s Co-operation and Competition Panel (CCP) a statutory body within Monitor “retaining its distinct identity”.

In addition, “the NHS Commissioning Board in consultation with Monitor will set out guidance on how choice and competition should be applied to particular services, guided by the mandate set by Ministers”. The NHSCB will also set clear expectations about offering patients choice through a “choice mandate”. Dr Evan Harris has stated that “this is simply reintroducing the marketisation of the NHS – rejected by (the LibDem) conference – by the back door of the NHSCB.”

To make matters worse there remains lack of clarity on EU competition Law, which could irreversibly open up the NHS to overseas providers competing for NHS contracts paid for by UK taxpayers.

3. Reducing the role of ‘Any Willing/Qualified Provider

According to the Government response, the revised bill will outlaw the Government now, or in the future, from naming the NHS as ‘preferred provider’. This clearly opens up the NHS to an “Any Willing/Qualified Provider” rather than reducing it. In addition, the staff “right to provide” policy will enable groups of clinical staff to set up their own social enterprises or “mutuals” and sell their services back to the NHS.

These are just a few examples of the ways the Government has crossed the “red lines in the sand” of the BMA and RCGP in order to stay on course with its original plans. It does not surprise us that the Lib Dem MP, Andrew George, who sits on the Health Select Committee, said: “If the Government had been listening it would have scrapped the Bill. Instead it looks as if they’ve just massaged and tweaked it a bit.”

Other examples in the Government’s response, which confirm its original direction of travel include: (i) the outsourcing of the function of commissioning to private companies, exposing the system to a whole new raft of even less identifiable conflicts of interest; (ii) the extension of personal health budgets; (iii) promotion of the choice agenda (which promotes competition); (iv) no mention of a reversal in the policy of allowing the NHS CB and commissioning groups to introduce additional charges for services they decide are not part of the NHS (Clause 22, para 14s of the bill); (v) retention of all the mutually reinforcing levers of a healthcare market (patient choice, competition between a plurality of providers, Payment by Results, and freedom for Foundation Trusts).

Thus, it is clear that the NHS will be subjected to increasing market competition and private provision and commissioning of services, which will undermine the founding principles of the NHS and drive it towards a mixed system of funding. In addition, the work of Lucy Reynolds from the London School of Hygiene and Tropical Medicine published in the BMJ last week also described how the bill could allow private companies to strip NHS assets “leading to more a expensive system that will deliver worse quality of care”. We therefore totally reject the repeated claims of the Coalition leaders that their reforms will deliver greater NHS efficiency and that there will be “no NHS privatisation”.

If all of this is not bad enough then even the supporters of clinically led commissioning must be highly concerned with a return of central control in the NHS via a strengthened NHS Commissioning Board and clinical senates. Thus, even the potentially “good part” of Dr Meldrum’s “Curate’s egg” has now gone rotten.

In conclusion, the simple fact is that the Government’s proposed changes to the bill are mainly cosmetic in nature. There are no ‘significant’ policy changes that will alter the general direction of travel of the reforms and we believe the proposals will actually create even more problems for the NHS by increasing the tiers of bureaucracy. It is at this point that we would remind Mr Clegg that “no bill is better than a bad bill”. He would also do well to listen to views of his fellow liberal Democrat colleague, Dr Evan Harris, who dismissed the NHS Future Forum’s paper on Choice and Competition as “cliché-ridden, trite nonsense” at the Social Liberal Forum last weekend.

It is incumbent on us as doctors to ensure our patients will always have access to a health service that does not differ across the country, a health service that is there when you need it and does not require an insurance policy or self funding if you need some extra care that your personal budget won’t fund. ?The NHS is facing the biggest threat in its history and as its founder, Anuerin Bevan famously said: ‘It will last as long as there are folk left with the faith to fight for it.’

We therefore urge members of the medical profession to take up the fight for the NHS by continuing to oppose this damaging bill and call for its withdrawal. We urge them to lobby their MPs, members of the House of Lords, and BMA representatives by highlighting what this bill means for the NHS, the profession and our patients.

Dr David Wrigley, GP, Carnforth, Lancashire

Dr Clive Peedell, Consultant clinical oncologist, James Cook University Hospital, Middlesbrough

Dr Jacky Davis, Consultant Radiologist, Whittington Hospital

Professor Ian Banks, President of European Mens Health Forum and Professor of Men’s Health, Leeds Metropolitan University

Mrs Anna Athow, Consultant Surgeon, North Middlesex Hospital

Written in personal capacities and all are members of BMA UK Council

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