In rejecting outright opposition to the bill, the BMA has had a huge mistake, says Dr Ron Singer
Representing the Medical Practitioners' Union – Unite on the GPC which has extensively discussed the Health and Social Care Bill, below is my assessment of the NHS changes and future campaigning options.
The BMA's Special Conference last month asked Lansley to withdraw his bill but stopped short of ‘opposition to the bill in its entirety'. So the BMA continues to engage with Government to make the Bill more acceptable and to support GPs rushing ahead (or being stampeded) into shadow consortia.
Some have adopted a BMA-like stance of ‘critical engagement'; some have voiced outright opposition to the bill. The most angry responses I have heard are from medical and nursing students smarting from the university fees row and now facing their life time's work in a fragmented and privatised health service.
The BMA is against privatisation of the NHS but supports aspects of the bill and, along with the GPC, has decided that GPs leading consortia will prevent the worst ravages of the private sector. I, and the organisations I work with, disagree fundamentally with both these views.
GP consortia (actually just ‘commissioning consortia' in the Bill) will be tied up in red tape as ‘statutory bodies', have a legal duty not to overspend their budgets and have little power over commissioning. Specialist commissioning – low volume services like neuro-surgery - will be the responsibility of the NHS Commissioning Board; A&E, ITU and so on, will be organised at supra-consortia level; elective care will be ‘patient choice' with the consortia reduced to bill payer.
Commissioning services for long-term conditions potentially allows consortia to shape local services but big providers may only offer a ‘ready-made', inflexible service to their local consortia, designed with cost-efficiency (profit) in mind.
Consortia will have to contribute to NHS savings of £5bn a year, an unprecedentedly high target. Consortia will therefore have to decommission health services and take the blame for the cuts they have to impose. Their second main function will be to ‘police' the care provided by member practices and pressure them to reduce referrals. Consortia risk becoming just as disliked and mistrusted as the PCTs they replace.
Led by GPs (private contractors to the NHS) with commissioning support from multi-nationals like KPMG who already have the London contract for supporting shadow consortia, consortia are the vehicles for privatisatng NHS commissioning. The rapid dismantling of PCTs and SHAs mean that committed NHS managers have received enhanced redundancy rather than remaining available to emerging consortia.
The 1989 Conservative government introduced the market philosophy to the NHS via GP fundholding and an internal market. Fundholding was countered by the MPU's ‘locality commissioning' a fore-runner of primary care groups. The current proposals cannot be successfully countered and will destroy the conceptual basis of our health service in England (Scotland, Ireland and Wales have minimal private sector involvement and no ‘market').
So what is an appropriate response?
The BMA, LibDems and many Labour MPs will try to amend damaging parts of the Bill. Amending the Bill cannot succeed because amendments that threatened the heart of the Bill – full-blooded competition, the market and the privatisation of providers and commissioners – would fall to the coalition's majority or break the coalition.
For me, my union, groups like Keep Our NHS Public only total opposition to the Bill ‘in its entirety' makes sense.
We must: inform our patients; build campaigns like the ones that defeated the poll tax and a Prime Minister in 1995; sign the national petition at www.38degrees.org.uk; oppose the Bill and reaffirm our support for the founding principles of the NHS. Where do you stand?
Dr Ron Singer
President, Medical Practitioners' Union – Unite.