NHS Consultants' Association

Andrew Lansley’s Health and Social Care Bill will fundamentally undermine the founding principles of the NHS by turning the NHS into a regulated competitive external market system, leading to increasing NHS commercialisation and privatisation. The public provision of healthcare will increasingly be replaced by private sector providers. This process will be driven by Clinical Commissioning Groups, which will buy in private sector commissioning support to help manage the new healthcare market.

This process will be catalysed by the £20 billion of efficiency savings required of the NHS by 2014-15. This will lead to increasing waiting lists, service failures and rationing of care, driving a new market for private healthcare insurance, top ups and co-payments. Struggling Foundation Trusts will need to treat increasing numbers of private patients to stay afloat. Hence the importance of the recently announced rise of the private income cap to 49%: NHS Hospitals in England will be allowed to use almost half their beds and theatre time for private patients.

This new market will lead to a more expensive, fragmented, and inequitable healthcare service. An increasingly commercialised and financially based system will erode medical professionalism and the social contract, thus fundamentally undermining the trust in the doctor-patient relationship that is so crucial to good clinical care.

The Bill is fundamentally flawed and is based on a philosophy of unfettered faith in market ideology, rather than evidence. The NHS has recently been shown to be a highly performing system by the Commonwealth Fund, and received its highest ever public satisfaction ratings in the recent British Social Attitudes survey. There is no democratic mandate for such a major top-down reorganisation, yet much of the reform is being implemented before the legislation has even been enacted. This is causing chaos on the frontline as PCT staff are being sacked and organisational memory is lost. It is also extremely costly, with estimates of the cost of the reorganisation now estimated at up to £4billion by the LSE’s Professor Patrick Dunleavey.

It is therefore of no surprise that there has been a major backlash from the health professions, with the BMA, Royal College of Nursing and the Royal College of Midwives, now all publicly opposing the Bill and calling for it to be withdrawn.

However, despite the widespread opposition from NHS stakeholders, the Bill continues on its journey towards Royal Ascent, aided by the Parliamentary maths of a coalition government, which gives it a majority in both Chambers.

It is painfully ironic, that if the Conservative Party had won an outright majority at the General Election, the Bill would have been blocked in the Lords by Liberal Democrat peers. Instead, Liberal Democrat MPs and peers are putting “politics before patients” to keep the coalition together to ensure their political survival. This is very bad news for those who value the NHS as a publicly funded, publicly provided and publicly accountable healthcare system. However, at this very difficult time, we should all remember the famous words of Aneurin Bevan about the NHS: ”It will last a long as there are folk left with the faith to fight for it.”

This famous phrase is the motto of the NHS Consultants’ Association and as co-chairman of this organisation, I felt it was my duty to try and live up to it in order to defend the NHS from this Bill.

I therefore decided to try and raise professional and public awareness of the dangers of the Bill by running 160 miles in 6 days, from Aneurin Bevan’s statue in Cardiff City Centre to the Department of Health in London in a symbolic protest. So on a damp Tuesday morning on the 10 January this year, I set out from Bevan’s statue in Cardiff with my colleague Dr David Wilson (a fellow Consultant clinical oncologist from Middlesbrough) with three mock postcards from Bevan, to personally deliver to David Cameron’s constituency office in Witney, Andrew Lansley at the Department at Health, and finally to Number 10 Downing Street.

The run was dubbed “Bevan’s Run” and I set up a blogsite and used Twitter to campaign along the way. (You can follow my Twitter timeline @cpeedell).

We ran 30 miles on the first day to finish on the English side of the old Severn Bridge. We were joined by Stefan Coghlan, chairman of BMA Wales for the first 13 miles. He has only intended to run 6 miles, but he pushed on to make it all the way to Newport station, where he borrowed £20 of me to get the train back.

Day 2 saw us run on to Tetbury (25 miles). This is when I developed left knee pain and required a knee support and 600mg of ibuprofen to carry on.

Day 3 took us through the Cotswolds and into Burford, at which point I developed right knee pain, requiring another knee support and more painkillers!

On day 4, we stopped off in David Cameron’s constituency of Witney, where we at least managed to get some local media attention. There was a rally in the Green of the Town Centre with speakers including Professor Allyson Pollock of Queen Mary University London; Prof Ian Banks, President of the European Men’s Health Forum; Dr David Wrigley of BMA UK Council; and Dr Jacky Davis, co-chair of the NHS Consultants’ Association. We then marched down the High Street to post “Bevan’s Postcard” at the Conservative Party constituency office. Later that day we stopped off at “Nye Bevan Close” in Oxford for another publicity opportunity and got onto Meridian News that evening.

Day 5 was a grim slog from Wheatley, Oxfordshire to Beaconsfield, where we delivered a “bonus” postcard to the office of Dominic Grieve MP, Attorney General.

On the final day we set off on a frosty, crisp morning towards Central London. We met up with some fellow “Bevan Runners” on the way, and six hours later, finally turned into Parliament Street to be greeted by a few hundred supporters outside Richmond House (Department of Health). The BBC cameras were there, but we didn’t make the TV news or even the BBC News website.

After some more speakers including Dr Clare Gerada, president of the Royal College of GPs, we headed off to Downing Street rattling a “Bevan’s bedpan” full of spoons to signify Bevan’s famous words about a bedpan falling in Tredegar hospital being heard to reverberate around the corridors of Whitehall. We handed our postcard in to Number 10 and then it was time for home, shattered and aching, but proud to have stood up for the principles of our fantastic NHS.

I think it is fair to say that we failed to grab the national media attention we needed to raise public awareness about the threats to the NHS from the Bill, but we did raise professional awareness with lots of coverage in the medical press. We are now seeing a groundswell of opposition to the Bill building up from the medical and nursing professions. The medical royal colleges are coming under increasing pressure to join the BMA, RCN and RCM to oppose this Bill. This could prove a fatal blow Lansley’s privatisation plans.

The NHS is too important for our society to lose. It is the glue that holds the social fabric together. All is not lost - we must continue the fight for the NHS.

This article was first published on the Open Democracy website.

The BMA - 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 organising some specialised 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 industrialised 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.

The NHS Consultants’ Association backs the BMA campaign to withdraw the Health and Social Care Bill.

Following the Executive Committee meeting of the NHSCA on the 4 August 2011, there was a unanimous decision to congratulate and support the BMA over its decision to mount a public campaign to call for withdrawal of the Health and Social Care Bill.

The NHSCA continues to believe that the Health and Social Care Bill represents the greatest threat to the NHS in its history. Despite the government’s proposed changes to the Bill following the Future Forum report, the key policy levers to deliver a full blooded market based system with increasing NHS privatisation remain intact. Worse still, the bill is now even more complicated and will be more costly to implement.

The Royal College of GPs has worked out that the number of NHS statutory bodies is going to increase from 163 bodies to 521! No wonder why Dr Hamish Meldrum, chair of BMA council stated that the Bill was: “Hopelessly complex and it really would be better if it were withdrawn.”

We are now left with a policy mess, at a time when the NHS is facing the greatest funding crisis in its history, with the QIPP efficiency drive aiming to deliver £20bn of savings by 2014. This will actually act as a catalyst to drive increasing privatisation of the NHS, as PCT clusters are forced to ration NHS care due to financial constraints, and NHS trusts come under huge financial pressure to cut costs.

We are already seeing an increase in NHS waiting lists and many PCTs reducing their lists of ‘NHS core services’, both of which result in increasing uptake of private health insurance policies. This has been widely reported in the media (here and here).

The Bill will also abolish the private practice income cap on foundation trusts, which will be under severe financial pressure to treat more PPs to increase their income. Some trusts will be forced into mergers, management takeovers, or even have to close down under the proposed legislation. This pressure will be increased with the introduction of new providers into the system through the ‘any qualified provider’ (AQP) policy, which is just a rebranded version of the previous ‘any willing provider’ policy.

The AQP policy is a key privatisation mechanism and is strengthened by the abolition of the NHS ‘preferred provider policy’. This will clearly impact upon the working lives of doctors as increasing numbers will find themselves working for private healthcare companies. Existing workers will have their terms and conditions protected by TUP legislation, but new employees to the NHS will not have these protections.

The most worrying aspect of the legislation is that once the Bill is enacted, the NHS is highly likely to be subjected to EU competition law because of the more open market nature of the system. This will make it nearly impossible to reverse the policies and the NHS will be finished as a comprehensive publicly funded, publicly provided and publicly accountable system.

It is therefore crucial that the profession backs the BMA over this public campaign to call for withdrawal of the bill. The presidents of the royal colleges should also be lobbied to back this campaign. This is the last chance saloon for the NHS and we must grasp it before it is too late.

Conflict of interest of author: Dr Clive Peedell is co-chair of the NHSCA and also a member of BMA council. However, the decision of the NHSCA exec committee to back the BMA was unanimous.