David Owen: Health care can never be only a market commodity

This wording in the Bill will have to be clearly amended to guarantee that the reprieve from price competition – announced in January – is firmly established. Only subsequently was the decision reinforced by Ministers. There must be no equivocation on this matter.

The test of whether an entity is an “undertaking” for competition purposes is whether it is engaged in an “economic activity” and whether it performs an exclusively social function based on the principle of national solidarity.

As commissioning consortia develop using the autonomy available to them under the Bill, it is by no means clear that they would benefit from exemption from competition law.

What needs to be established by careful amendment to the Bill is that NHS commissioning services will be exempt from competition law, given that they will be fulfilling a statutory social mission and not acting as economic “undertakings”.

Another difficult issue not really dealt with in the Bill is how to deal with the undoubted conflicts of interest for GPs fulfilling both their commissioning and providing roles.

The patient-doctor, patient-nurse relationship is personal, intimate and largely unquantifiable. The internal market is a device that can create a climate helpful to managing the NHS, and in general it has done so, but the moment the patient believes that the decisions of doctors and nurses are taken on cost grounds as the result of competitive trading the relationship of trust will alter.

Politicians are embarking on a course involving the deepest conflict with age-old values, traditions and concepts of respect and the public good. Health is not a market commodity.

There is no escaping the fact that providing choice is expensive, and it is no surprise therefore that PCTs have, in practice, been doing their utmost to limit patient choice. A Department of Health report has highlighted some of the strategies being pursued by PCTs in order to balance their books as the financial crunch begins to take effect.

It found that almost half of all PCTs were taking steps to frustrate policy on competition and patient choice.

The changing nature of medicine, with shortening hospital stays and the rise of community-based care, raises new threats of disintegration in care.

Sharing patient information between both settings can be beneficial to the quality of care. Having strong relationships between commissioners and providers is crucial, and the volume of interaction required for some types of care is simply not possible within a fragmented and unco-ordinated environment of “any willing provider”.

We must start to ask of our politicians: is healthcare just a commodity to shop around for?

Do they really want to fashion NHS health care as if it is just a commodity?

Do they want medical practitioners to appear evermore as commodity managers? Some practitioners do, others may, many will not.

The NHS has provided the best system yet devised for rationalising health care. Surprisingly, despite its relatively low investment, only recently improved, all along it has retained high satisfaction rates and the provision of good quality care with universal coverage.

This legislation towards an external market in health care puts this proven balance in jeopardy. It warrants very careful thought, before being voted onto the Statute Book, particularly since close scrutiny of the experience and evidence accumulated from the internal market of the past 20 years does not justify such a revolution.

At the very least, these substantial proposals that affect the founding principles of the NHS must be given the time and consideration they deserve.

Referral to a Select Committee of the House of Lords, as part of an acceptance of its Second Reading, is a very realistic possibility rather than subjecting this Bill immediately to an ad hoc battle of amendments between the Lords and the Commons.

David Cameron will hopefully act long before this happens in the summer and replace the existing health ministers in the House of Commons and allow for fresh thinking, and much less dogmatism.

Such a decision would allow the coalition Government to return to its primary task of helping the NHS deliver the major efficiency savings they have already calculated as part of the necessary reduction in the UK’s deficit.

Lord Owen is the author of a new pamphlet Fatally Flawed: Yes to the NHS Internal Market – No to the External Market which can be found at www.lorddavidowen.co.uk

* Lord owen is a former Minister of health and Foreign secretary. he was Leader of the SDP from 1983-90. he sits as an independent Crossbencher in the house of Lords.