Recent surveys of the profession by the King’s Fund, the RCGP and the BMA have all shown that the majority of doctors do not support the reforms and do not think they will improve patient care.
Following last week’s publication of the Ipsos MORI survey of BMA members in England, the chairman of BMA council, Dr Hamish Meldrum told BMA members that: “There is a central plank of policy that concerns you the most: competition. Almost nine-out-of-ten doctors believe that increased competition brought about by allowing ‘any willing provider’ to tender for services, together with handing enforcing powers to the economic regulator, Monitor, will fragment care.
“The Secretary of State has repeatedly said he wants to listen to doctors. Doctors are telling him that whole rafts of these proposals will either not achieve the intended benefit to patients, or will be harmful. He particularly needs to act on the concerns about competition.”
However, competition between a plurality of ‘any willing providers’ is the fundamental policy underpinning Mr Lansley’s market driven reforms. In fact, competition is the lifeblood of any market system. Lansley himself has stated that: “The first guiding principle is this: maximise competition. There are, of course, potential benefits from privatisation in terms of access to capital, flexibility, and creating new markets; but private sector ownership is a secondary consideration to competition, which is the primary objective.”
Hence many of the other policies in the Bill are designed to promote competition. Thus he is empowering Monitor to be “a strong, pro-competitive regulator”, which will be “geared to maximising competition or enforcing contestability where competition is absent or limited”.
Monitor will also have concurrent powers with the Office of Fair Trading to apply competition law to prevent anti-competitive behaviour. In addition, the NHS Commissioning Board will also have a duty to promote competition.
Crucially, one of the key reasons for transferring £80bn of the NHS budget to GP consortia is to promote competition within the NHS by getting the money as close as possible to the patient (consumer). Mr Lansley explained this in a speech in 2005: “The statutory formula should make clear that choice should be exercised by patients, or as close to the patient as possible, thereby maximising the number of purchasers and enhancing the prospects of competition, innovation and responsiveness to patients.”
Since competition is so fundamental to Lansley’s market based reform agenda, any successful amendments to the Bill that removed the competition element would essentially render the Bill null and void in terms of its main aim of being the blueprint for a market-based healthcare system. However, this is precisely what the BMA are trying to achieve in their attempts to amend the following clauses: Clause 63 - by removing powers to impose requirements to promote competition; Clause 52 - by removing Monitor’s duty to promote competition; and Clause 60 - by removing Monitor’s concurrent powers with the Office of Fair Trading to apply the Competition Act 1998, following the model used in various utility industries.
Although the BMA is still critically engaging with the government and has not joined in with calls for total opposition to the Bill, the BMA is actually proposing anti-competition amendments, which if accepted, would cause the Bill to fall and almost certainly signal the end of this coalition government. It is precisely because of this risk that there is no realistic prospect that these amendments will be accepted in any shape or form.
Since the Bill is very complex and not well understood, the public, the media and the profession have not realised the significance of the BMA’s proposed amendments, which have fallen under the radar. Thus there is too little public attention and opposition at present and the Bill is therefore very likely to become enacted relatively unscathed. This will signal the demise of the English NHS as a publicly funded, publicly provided and publicly accountable universal healthcare system.
This raises the stakes for next week’s BMA Special Representative Meeting (SRM), which is vital because it will offer the best and possibly the only opportunity to save the NHS from Lansley’s radical market reforms. Over 500 motions have been submitted. Crucially, these include motions calling for complete opposition to the Bill, as well as a vote in no confidence in Mr Andrew Lansley.
If these motions are passed, then this will send out a very strong message to the media and the public that grassroots doctors have mandated their leadership to oppose the Bill in its entirety. Since empowerment of doctors was supposed to be one of the key selling points of Lansley’s proposals, outright rejection of the Bill would carry enormous weight.
I believe that the public are the key to saving the NHS, but the legislation and its processes are so complicated that they are not engaged at present. Most doctors don’t understand the implications of Clauses 52, 60 and 63 either, let alone the public. This is why a public display of grassroots doctors rejecting Lansley’s reforms in their entirety at the BMA SRM is so important. This would be a profoundly symbolic moment, which could stimulate enough media and public interest to turn the tide decisively against Mr Lansley. Once the public get a whiff of what his plans really mean, this Bill is in trouble.
This is why I implore BMA members who are attending the SRM next week to vote for total opposition and also add a vote of no confidence in Mr Lansley. We need to defend the NHS from increasing commercialisation and marketisation and the medical profession needs to lead - the public will do the rest.
If we don’t take this opportunity the public will not be forgiving. We should heed the lessons from the experience of the medical profession in the US healthcare system. Between the mid-1960s and the mid-1980s, when the US was becoming increasingly commercialised, public confidence in medicine and health institutions dropped from 73 to 33%. While all major American institutions experienced a loss of public support, the medical profession lost support faster than any other professional group.
