“Are you political, then?” I was asked by a colleague yesterday who had noticed my “doctors say stop the bill” badge fixed proudly to my dress, beside my ID badge and stethoscope. Yes I am. But you don’t have to be “political” to be against this bill. You just have to want an NHS free at the point of need; an NHS in which clinicians are making decisions based solely on your clinical need; an NHS in which you can’t buy your way to the front of the queue; an NHS in which all money goes towards patient care, not shareholders. If you believe in equality and democracy you must make your voice heard, or forever regret it.
So here is a summary of why I, as an NHS doctor, citizen and patient am against the bill. At the end are things you can do to get your voice heard.
1. The government has failed to show that this massive, top-down, reorganisation of the NHS is “vital” as it claims. The NHS needs reform. No-one doubts this. But this bill is not the answer. There is no clear vision of what is trying to be achieved. I have not heard a single politician articulate the aims of the bill. In fact the changes that politicians, patients and doctors agree would be beneficial, including shifting decision-making powers to clinicians and streamlining patient pathways do not require legislation, and can be achieved without wholesale structural change.
2. The government has no mandate for the destruction of the founding principles of the NHS. The changes proposed in the bill were not in the Conservative or Liberal Democrat manifesto. They were not in the coalition agreement. There has been no vote. The government has already started implementing parts of the bill before any House of Lords approval or Royal Assent. This premature and rapid implementation is already causing chaos on the ground, destabilising services. The government has also blocked demands to publish the risk register, and is ignoring the ruling of the information rights tribunal to publish it, underlining its total lack of respect for public opinion and democracy. The last time similar actions were taken was when there was a public demand for release of the legal advice the Blair government received about the legality of military action in Iraq, prior to the start of the conflict in 2003. We all remember how that turned out. The government has also ignored the e-petition and refused to hold a debate, despite gaining far more than the required 100,000 signatures. Pushing forward with the bill is undemocratic, autocratic and wrong.
3. Privatisation will increase under this bill. This is bad for patients. The record of private company involvement in the NHS is not good. PFI may have created a few sparkly hospitals but taxpayers will continue to pay extortionate amounts for this privilege for years. Private companies only want to undertake simple, straightforward procedures in patients who are low risk. Not only does this leave out many older people with multiple co-morbidities, but when any patient has a procedure done privately, complications are dealt with in the NHS. The PIP implant disaster exposed the fact that private companies cannot be held accountable by the government; have no obligation to collect or supply accurate information about what they are doing; fiercely resist any duty of care to patients; and are more concerned with cost than quality. Look forward to more of this, not just in relation to cosmetic surgery. Private companies want all the profit, none of the risk and this bill hands it to them.
4. Those expected to implement the bill do not want it. The coalition have attempted to sell the bill to the public on the basis of clinician-led commissioning, giving power back to clinicians. Well, clinicians have made their opinion clear. Name a professional body and you can find a statement opposing the bill. Every day I am thankful that I am free to make decisions with patients based on clinical need, not cost. In all but a few specialist circumstances, such as new and expensive cancer drugs, cost never enters clinical discussions in the NHS. And we want it to stay that way. GPs, the clinicians who supposedly have the most to gain have made it clear that they do not have the time or skills required to deliver commissioning in the proposed model. They are first and foremost doctors, not managers. Therefore the CCGs will outsource to private companies. More public money in the hands of shareholders, rather than patients.
5. The bill will introduce more bureaucracy, which will cost, and will distract from care-giving. It will replace three layers of management in the NHS with at least six new ones. Many of the staff in primary care trusts have already left, returning to work for the commissioning groups and commissioning support services, often as consultants on a higher salary. This bureaucracy will not only slow down innovation and change, but will be hugely expensive. Management costs in the NHS are about 5% of the total budget. In the healthcare system in the US they are above 25%. It is a fallacy that markets drive efficiency. If the bill is passed, management consultants such as McKinsey and KPMG will make millions from the NHS budget “advising” clients on both sides of the purchaser/provider split, with additional contracts “advising” government and health regulators how to cope with the tangled web of contracts the new system would create.
Nye Bevan, founder of the NHS said “the NHS will survive as long as there are people left with the faith to fight for it”. I have faith. Do you?
Write to your MP, adopt a peer, write to your local paper, tell everyone you know, twitter your thoughts with #SaveOurNHS #dropthebill, directly tweet MPS eg @nick_clegg, @SWilliamsMP, @VinceCable #LDConf #lostvotes.
Other people have said all this and more, much more eloquently then me. Here are a few examples:
3. The Lancet’s summary, highlighting the failure of the bill to safeguard the core principles of universal care and the duties of the Secretary of State to uphold those principles. “The duty on the Secretary of State to provide or secure provision in accordance with the founding legislation of the 1946 Act must be restored if England is to have a national health service.”