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The battle for the health bill is lost

The health bill has alienated so many that the only way forward is to scrap it and start again, says Dr Kailash Chand.

We are coming to the end of ‘the listening exercise’ this week .The purpose of which essentially was to neutralise the wide spread anger, buying time, and appearing to listen.

By all accounts the Health and Social Care Bill is now more confusing than ever, with David Cameron, Andrew Lansley and Nick Clegg singing from different hymn sheets. The result would be a mishmash of political ideology and competing ambitions.

In a politically led NHS the politicians and their advisers seem dangerously disruptive and distracting. The destruction of the NHS is going on unabated, without the political mandate to do it. In my view, getting the bill through Parliament for political compulsions would leave the NHS in a worst state than ever.

We all know that the real reason for the bill is to allow unfettered access for the private sector, turning an integrated service into one where competition on a commercial basis is the driving force, but there is no systematic evidence that commercial companies provide better quality, more efficiently.

The Institute for Public Policy Research rightly argues in a report that increasing the role of the private sector in the UK health system will not make the service more efficient. Governments that have tried to shift costs from the public to a private purse rarely save, and sometimes, increase costs.

For example, France’s system of high charges for services such as seeing a doctor or treatment as an outpatient has not controlled their rising healthcare budget. The report also argues against attempts to fund this ‘health gap’ by shifting costs from the public to the private purse, for example by more private insurance, or co-payments. There is nothing to suggest that this is what the people of this country want, so the bill must be opposed, not cosmetically adjusted, by all who value the concept of a national health service.

Reducing bureaucracy is a popular idea, but it is not strong enough to justify the policy. The King’s Fund’s chief executive Professor Chris Ham has nailed another myth from Mr Lansley that the massive administration costs will be reduced by abolishing PCTs and SHAs. In a report released last week he says creating new bodies, such as consortia and health and well-being boards, ‘is likely to be an increase in management and administrative posts, not a reduction, and not necessarily an improvement in either management or leadership.’

I accept the current accountability arrangements are not acceptable, but the removal of the secretary of state from day-to-day decision making and passing the responsibility to consortia will not be an improvement. Putting local councillors to consortium boards will not solve the problem; it is a strange logic to depoliticise the NHS at national level only to politicise at local level. In a universal health care paid by central taxation the public and Parliament rightly expects national accountability.

Contrary to the Government’s emphasis, the Tory-led coalition Health and Social Care Bill will do little to tackle the major contributors to premature death in this country: obesity, alcohol misuse and smoking. These can only be addressed effectively by tackling fast food advertising and the marketing of alcohol as glamorous and tobacco displays in large supermarkets.

Somewhat perversely, Mr Lansley is seeking the assistance of fast food and drinks corporations to help draft strategy in public health reforms. The idea is to replace state intervention with private and corporate action. The giants of the food industry, such as Tesco, Mars and PepsiCo, are to be assigned the task of behavioural change with a view to ‘nudging’ the public into better choices, instead of having government regulation of public health.

As it stands, Mr Lansley’s plan to put the food industry and drink industry in the driving seat will reverse any progress made in past two decades on public health, and will further fuel obesity and alcohol abuse. The NHS bill for the treatment of acute illnesses will keep on soaring and our society will be the poorer for it – in both financial and health terms.

The bill is heavily contaminated with the Tory philosophy and dogma of privatisation, so that even if the constitution of commissioning bodies is altered to include not just GPs but other professionals too, the bill has alienated so many that the only way forward is to wipe the board clean and start once again. Even if the parliamentary arithmetic may get the Health and Social Care Bill through in a modified form, making that legislation produce improved performance in the NHS, better value for money for the taxpayer, and better clinical outcomes for patients requires the support and engagement of the stakeholders. The current strong opposition across key groups like BMA, nurses and managers represents a justified challenge to the reforms.

The best service Professor Steve Field could do for the NHS and the profession is to recommend scrapping the bill and start afresh. No bill is better than bad bill.

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

Dr Kailash Chand