The Government's plans for the future of the NHS propose the most radical shake up since it was founded. It is nothing short of a massive gamble with the future of one of this country's most cherished and important institutions.
The new Health Bill contains some elements difficult to argue with and which have the potential to deliver real benefits to patients. It makes provisions for the greater involvement of doctors in planning and shaping the NHS, more empowerment of patients and a focus on quality. Taken together, the hope is that your local GPs, in partnership with their colleagues in hospitals and elsewhere, could come together and "commission" the best, high-quality services for the specific needs of their patients in different parts of the country, like Yorkshire. This sounds good.
But this potential to devise a flexible, locally relevant NHS is threatened by other parts of the Government's flawed agenda. In particular, the legislation will mean that competition will be forced on the new clinical commissioners even where they believe the best services can be provided by local hospitals.
One of the British Medical Association's (BMA) biggest concerns in this context is about the role of Monitor, the new economic regulator for the NHS, that will be tasked with encouraging competition. If GP consortia, using their professional judgement, decide their patients are best served by commissioning a service from their local NHS hospital, Monitor would be able to undermine that decision if it believed other providers had not been given the same opportunities to compete. This will turn the NHS into a full-blown competitive market where competition is enforced rigidly across the NHS. It will also allow large commercial companies to use their economic power to chase the most profitable and easy-to-run contracts while, at the same time, undercutting NHS providers and other groups.
Once they have this business, companies will inevitably focus on making the most profit out of their specific contract to satisfy their stakeholders, an approach that could destabilise other local services and fragment care for patients. Although remaining free at the point of use, a fundamental part of the ethos of the NHS, that we should have a co-operative planned approach to healthcare, could wither on the vine as the market runs riot.
Another danger is that within these contracts commercial companies may choose to focus on the less complicated, more profitable elements of healthcare at the expense of more difficult procedures. We saw this so-called "cherry picking" with the private independent treatment centres set up under the last government. It makes perfect financial sense if you're a business with shareholders to please. If a private business has an ophthalmology contract, they will find it difficult to resist the desire to focus on churning through simpler, more common cataract operations rather than devoting time to other, more complex procedures.
This is because it is likely that these operations will be less profitable as they often require expensive intensive care unit beds to be available in case of emergencies or if further immediate care is required. Private hospitals often don't have these beds or units as they are costly to build and staff.
Moreover, doctors in training will, as a result, be given less exposure to complex procedures. Training for our hard-working junior doctors is therefore another important strand that could be affected indirectly by this dash to the market.
What makes the situation even worse is that the Government is going ahead with these changes at breakneck speed, at a time of huge financial pressure and with an instruction to make savings the like of which the NHS has never attempted before – far less achieved.
The Government has already announced that the NHS must find 20bn in efficiency savings over the next four years, a huge figure that we believe will lead to real cuts in frontline patient services.
Not all of these will be felt immediately, but as managers begin to grapple with the implications they will become more apparent throughout the whole country, including Yorkshire, in 2011 and beyond, as well as the rest of the NHS in England. Already the BMA has had reports of hernia and varicose vein services being reduced in some areas, as well as reductions in healthcare visitors in the community.
Tackling this budgetary crisis would be hard enough in normal times, but many NHS staff and experts are rightly worried how the health service will cope when it is also expected to completely reorganise its structure and face a potential onslaught from the private sector.
The NHS has served this country well, but it does need reform. For many years the BMA has said it needs to be more responsive to what patients need locally, so that places like Yorkshire get a more flexible service that meets their specific needs. Locally-led commissioning could allow this to happen.
But this incredibly lengthy and complex Bill, which everyone is still digesting, contains many dangerous proposals that have the potential to destabilise and disrupt our NHS. The BMA will be taking a very strong lead in articulating the concerns of your doctors directly to Ministers.
It is important that, as the Bill begins its passage through Parliament, the Government starts to listen to the chorus of voices that are asking it to think again, before it is too late.
Hamish Meldrum. Dr Hamish Meldrum is a Bridlington GP and chairman of the British Medical Association.