Hamish Meldrum: The whole direction of planned NHS ‘reform’ is wrong

He’s right that the NHS is hugely important to families, and I don’t doubt for a moment how important it has been to his.

He’s also right that we’re facing enormous challenges as a result of our ageing population, and the mounting costs of new drugs and technologies. And he’s right that the NHS needs to change.

Where I don’t think he is right is on his Government’s proposed solution to these challenges.

The Health and Social Care Bill that is currently going through Parliament – or was until its progress was “paused” – has the potential to do real damage to our NHS as we know it.

The problem is not with small details that can easily be ironed out but with the whole direction of travel.

As it is currently written, the Bill would fundamentally change the ethos of our Health Service, moving us even further away from a system based on co-operation between different bits of the NHS, to one where they are pitted against each other in a market-based system.

Perhaps the greatest problem is that the proposed economic regulator would be given a statutory duty to promote competition in the NHS.

In practice, that could mean GP consortia – which would be responsible for buying in and developing new services for patients – being subjected to competition law.

The risk is that instead of spending all their time and energy on improving services for patients, they will be distracted by the possibility of a legal challenge, always worrying that a decision to contract a service from their local NHS hospital could result in them being sued by a private healthcare company.

The other crucial point to bear in mind about competition is that it doesn’t work in every area of life. It might work when you’re choosing between cans of beans, or mobile phone operators, but that doesn’t mean it works in health – particularly in a Health Service that’s funded by the state.

If you’re a widget-making company, you succeed by selling more and more widgets, but if you’re an NHS healthcare provider, success should mean keeping people healthy and keeping costs and hospital admissions down.

And, crucially, the consequences of failure are far, far more serious in health than they are in other sectors.

Competition won’t be good for you if it means the hospital you’ve visited for years closes because it’s lost the services and funding it needs to stay afloat. Or if it means the services you need to deal with your chronic condition wither away because they’re not profitable.

Sometimes when the BMA, and the other organisations that represent NHS professionals have raised these concerns, we’ve been accused of being anti-change. This definitely isn’t the case.

NHS staff know all about change – they’re constantly working to improve care for their patients – whether it’s a hospital consultant introducing an innovative surgical technique, or a GP practice finding better ways to manage care for patients with diabetes.

The major improvements we see in the NHS – like better treatments and reduced death rates, have often been achieved through staff having the ideas and commitment to make things better.

What will happen to the Government’s plans now is very difficult to predict. David Cameron’s speech made clear his continuing commitment to reform, while hinting that there will be concessions. What these will be and how far they will go remains unclear.

The party politicking behind the reforms is complex and ever-changing, with Nick Clegg trying to reposition the Lib Dems as a more assertive, muscular partner, and the Prime Minister reluctant to back down.

Whatever the result of political horse-trading, I really hope that the message has got through during this listening exercise. It’s not true that these reforms are the only way forward. There is an alternative – it’s an NHS based on co-operation where staff can work together in the interests of their patients.

Dr Hamish Meldrum is a Bridlington GP and chairman of the British Medical Association.