NHS reforms are this government's poll tax | Kailash Chand
As the health and social care bill receives its second reading, one GP explains why he sees Andrew Lansley's reforms as a toxic prescription
This proposed bill is the biggest challenge to core NHS values. The coalition is planning to turn the NHS over to a plethora of private companies who either commission or provide services, or both. The government's dismantling of the National Health Service has a genealogy running from Margaret Thatcher through the years of Tony Blair and Gordon Brown to David Cameron's coalition. The last Labour government laid the groundwork for everything the coalition is planning to do to the NHS. Market structures, foundation trusts, GP consortia and the introduction of private corporations into commissioning were all products of the ill-conceived Labour vision of "public service reform".
The idea that competition breeds excellence and market forces make everything more efficient is a myth anyway. Two successive governments have now shown that simulating a market ethos in the NHS might bring blips of success, but it carries the potentially fatal consequence of producing erratic behaviour from otherwise sensible people.
Theoretically the bill sets out just how everything should function. But almost nobody except Andrew Lansley and a few around him quite believes that they will. Certainly most doctors don't; the BMA and the independent King's Fund certainly don't, and so far as I can judge nor do most of the MPs including Tory and Lib Dems. Even the health select committee, which is chaired by a former Tor! y health secretary, Stephen Dorrell, has strong doubts. The scope and complexity of the bill is immense, and it will have a significant impact on NHS services, its workforce and public health.
Why do I have serious misgivings? Apart from the threat of piecemeal privatisation, there seems to be no clarification on what happens if GPs run out of money before the end of the financial year. What happens if GPs will not refer patients to the hospital of their choice because of cost? If a patient is referred to the cheapest provider on financial consideration, will he/she get the best treatment? If hospitals cannot attract "business" from GPs, will they be privatised? How will the conflict of GPs who are both providers and purchasers be managed, and what impact might this have on their local hospital?
The legislation proposes a market-based approach that must involve competition between "any willing providers". This supposes that GP consortia would be able to favour their local provider and build excellent local services. The consortia of GPs established to spend 80 billion on commissioning will become rationing committees, choosing which services should be cut and which groups of patients should lose out. Patients' lives are about to rest on the bottom line of the GP's budget.
There is likely to be intolerable pressure on clinicians to dilute their needs-led approach to patient care and instead consider all manner of economic and other factors. Patients should be worried, because GP practices are not set up to do this. They are clinical enterprises, not businesses. Saying "no" to patients does not come easily to GPs.
At the heart of 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 t! radition al health service to one ruled by bogus choice, competition, market forces and supplier diversity. And in this sort of health service the chronically and terminally ill, the mentally ill, those from lower socio-economic groups and the elderly are likely to lose out. The young and able and the privileged who have ease of access to health.com will be likely winners.
This legislation is the NHS equivalent of the poll tax. We need to resist the introduction of enforced competition, competitive pricing and the imposition of foundation trust status on all hospitals. Ploughing ahead with these changes as they stand, at such speed, is an enormous and costly risk at a time of huge financial pressure.
What we need is a bold, active and high-profile campaign from the independent media, trade unions and the BMA. Everyone who cares about the NHS must push this issue to the top of the political agenda and give hope to all those of us who fear the deadly effects of Lansley's prescription.
Dr Kailash Chand OBE is a GP and chairs Tameside and Glossop NHS. The opinions expressed are his personal views.
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