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Last chance to extinguish this threat to the NHS

After some cosmetic changes, the health bill has become more complex and harder to deliver. We have to persuade the Lords it should be scrapped altogether, says Dr Kailash Chand

 

The Government's controversial health bill survived an important vote in the House of Commons early this month, taking them a step closer to becoming law.

From 11 October, the House of Lords starts voting on Andrew Lansley's toxic NHS plans. The peers have a choice - will they force the Government to make changes to protect our beloved NHS? Or will they wave through plans that threaten our health service? The Lords may want to ask whether this bill is necessary given the current state of NHS finances.

The NHS was formed in 1948 so that all British citizens had equal access to the best medical care, not just the rich. And so that the NHS can continue to cope with demand, politicians of all colours have reformed it in many different ways.

These reforms, however, have endured a rough ride, with progress paused earlier this year after criticism from health professionals, trade unions, academics and Liberal Democrats, notably Dame Shirley Williams, the House of Commons Health Committee, the King's Fund, andnow even from veteran right-wing Tory Lord Norman Tebbitt.

Prime minister David Cameron's speech in Parliament suggesting that health workers and the Royal Colleges are now fully supportive of the bill is somewhat disingenuous and shows the low standards that are being applied to the spin of the bill, at the expense of ignoring what will be disastrous changes to the NHS.

The pause made some cosmetic changes that have made things more complex and harder to deliver. My huge concern is about the failure to impose a cap on private practice in NHS hospitals. Let's set the record straight: I am not against private healthcare. I simply object to private hospitals being given priority over NHS hospitals, putting the NHS at risk.

Over time, all hospitals will have to become foundation trusts, effectively commercial bodies. They would have the power to close services without public consultation, and caps on income from private patients in NHS hospitals will be removed, tempting many to increase their income at the expense of NHS patients. Foundation trusts will chase after private business to the detriment of their NHS patients from socially and economically deprived groups.

No one says the NHS is perfect. Most of us want NHS reform so that the taxpayers' money can be well spent for meeting new challenges, like obesity, the ageing population, alcohol-related illness and spiraling demands. But health secretary Andrew Lansley's recipe of GP commissioning, abolition of primary care trusts and strategic health authorities, with no coherent structures to replace them, the introduction of private providers into the NHS, and emphasis on cost, rather than quality of service, lays personal dogma before rational political justification for reform.

Further, the concerns about GPs' capability and conflicts of interest persist. It is a complete myth that GPs in commissioning groups will have a huge impact on designing services, and as Pulse's investigation recently showed, nor is there widespread engagement with the Government's reforms.

Emergency services like A&E will be commissioned at a population of a million. Tertiary services like neurosurgery, will be commissioned by the NHS Commissioning Board. Elective care such as cataract and orthopaedic surgery, will be via patient choice arrangements. The bill may have some influence on long-term conditions, but this too may be tricky, as the providers with one eye on profit will come with a fixed package with very little leverage to change especially if that increases their costs and is therefore bad for profits.

At the heart of Mr Lansley's agenda may be the complete privatisation of the NHS a process that has deep roots in Thatcherite ideology. We may be witnessing the end of the NHS as a publicly-provided, publicly-financed body. We are moving away from the traditional health service to one ruled by bogus choice, competition, market forces and so-calledsupplier diversity. And in this sort of health service the chronically and terminally ill, the mentally ill, those from lower socio-economic groups, immigrants and the elderly are likely to lose out. The young and able and the privileged who are internet savvy will be likely winners.

The NHS has not faced this level of challenge in its history. The vision outlined in the Health and Social Care bill is one in which corporate interests will be driven by incentives to select patients, time-limited care, selling top-up insurance and introducing charges for some elements of care no longer provided by the NHS.

These reforms are based on the privatised US system, the most expensive and highly inequitable healthcare system in the developed world. If they Government continues to press ahead, privatisation and poor patient care will plague the NHS. The truth is that universal healthcare provided by the NHS – once the envy of the world is in serious danger of becoming extinct.

In my view, this is a bad, unwanted, unnecessary and ideologically driven bill heavily contaminated with the Tory philosophy and dogma of privatisation. It has alienated so many that the only way forward is to wipe the board clean and start again.

The battle is far from over, nearly half of English Lib Dem backbenchers defied the Governmentand refused to back the plans. More than 150 scientists, surgeons and doctors have written to NHS professional bodies calling on the medical establishment to demand that the Government withdraws its controversial health bill. The letter says the health bill, devised by the health secretary, Andrew Lansley, is not supported by the majority of the medical profession and is not in the best long-term interests of either patients, doctors or the Royal Colleges.

Remember, Lansley's plans can't become law unless the House of Lords votes them through. The House of Lords - where the plans haven't been voted on yet - needs persuading that this bill is so faulty that it needs to be withdrawn.For socially deprived, black and minority ethnic communities the stakes are high. Medical evidence shows that obesity, diabetes, hypertension and other chronic illnesses are endemic in our communities, and these illnesses are more demanding for medical attention and multiple prescriptions.

There is no doubt in my mind that if these reforms go through unchallenged, the effect will be that many in the socially deprived communities will face an uphill struggle trying to access good medical care because resources will be diverted towards private provision and income generation.

We need to persuade the House of Lords to stop Lansley's threat to our health service. Preventing the destruction of the NHS will ultimately come down to the votes of 91 Lib Dem and 184 Crossbench Lords.

Dr Kailash Chand is a GP and chair of Tameside and Glossop NHS

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