The Government has told us, on several occasions, that its reforms of the NHS have the backing of the health professions. An open letter from 400 experts in public health urging peers to reject the Health and Social Care Bill when they vote on it in the upper house tomorrow would suggest otherwise.
Not only that, but an internet appeal for funds to pay for legal assistance in lobbying the Lords raised over £74,000 in a couple of days (they had hoped to reach £20,000). We’re a canny lot, doctors; we don’t put our hands in our pockets lightly, and I haven’t met a single medical professional who thinks the Bill will be anything other than detrimental to the NHS.
It is quite clear that we can’t believe anything that David Cameron says on this issue. But then we already knew that – particularly if, like me, you voted Conservative last May, largely on the back of his promise of “no more top-down re-organisation of the NHS”. The first thing he announced on getting elected? Andrew Lansley’s biggest ever top-down restructuring of health care.
Just to be absolutely clear, far from being a left-winger or liberal with an unswerving devotion to socialised medicine, I’m actually a pragmatic right-of-centre sort of chap, who thinks that we could do with more pluralism in health care funding (funding, note, not provision), with a mix of private insurance and public taxation along mainland European lines. So why are I and my colleagues so opposed to this Bill?
First of all, there is this political conviction that commercial providers are likely to provide a more cost-effective service than the public sector. Logic and experience tell us that this is unlikely to be the case. Private firms have to make a profit, whereas the public sector does not, so they can only undercut NHS providers if the latter are inefficient or if they, the private providers, are prepared to compromise on quality. Well, we used to be inefficient, but we have now been under pressure financially for so long that the year-on-year “cost improvement programmes” have squeezed all the fat out of the system.
The only other way private providers can make a business case stack up is by artificially inflating the degree of risk inherent in contracts, as they did with the connivance of New Labour – resulting in the ruinous PFI profligacy of the previous Government.
We already have more than enough experience of private sector involvement to confirm that it tends to waste money rather than save it. The two high-tech procurement programmes that I have direct experience of in my own specialty resulted in the expenditure of millions of pounds of taxpayers’ cash that could have been saved if we had just been allowed to get on with the job ourselves. Having mentioned quality, let’s come back to that important issue. The initial draft of the Bill talked about allowing “any willing provider” to tender for NHS contracts. A bit worrying that, if you think quality is important.
The Government’s “listening exercise” (I see no evidence they actually heard anything) resulted in a change of definition to “any qualified provider”. But don’t be reassured by that. All it seems to mean is that the successful companies need to be subject to regulation by the Care Quality Commission. That’s right – the same outfit that was regulating those dreadful care homes exposed on Panorama.
A second big concern is the fragmentation of services that will result from the changes. One of the biggest criticisms of the NHS over the years has been the lack of joined-up thinking. If anyone thinks that the involvement of multiple private and public providers will result in a more unified whole, I suspect they are in for a nasty shock. The other big change is the transfer of responsibility for the commissioning of health services to Clinical Commissioning Groups. The increased clinical involvement is welcome, but could have been achieved painlessly by modifying the current structures.
Despite reassurances from Government, what we hear on the ground are tales of chaos as staff are made to apply for jobs in the new commissioning groups, with no-one sure who is responsible for what, and who is heading for unemployment. The same end could have been achieved by a process of evolution. We have seen enough reorganisations over the past 30 years to know the result will be confusion and inefficiency. Either David Cameron really doesn’t believe his Bill will damage the NHS irretrievably, in which case he just doesn’t understand the issues, or he doesn’t care.
Time is running out for those of us who want the Government to stop and think. The Lords debate on the second reading of the Bill begins today, ahead of a crucial vote tomorrow.
If you are worried, email a Peer at http://action.38degrees.org.uk/assign/contact-a-lord, and tell them how you feel. You can also sign a petition to protect the NHS at http://www.38degrees.org.uk/page/s/Protect_our_NHS_Petition, and add your name to the 440,000 already signed up.
Or you could just hope for the best.