Yesterday the BMA passed a series of motions extremely critical of the NHS bill now before Parliament. It is worth considering what are the implications of these proposals. There is some justification to fear that they will lead to a break up of the NHS. "Any willing provider" will be able to takeover any of the services provided by the NHS. The danger is that our NHS will be reduced to a logo, backed by public money, while unaccountable profit-making companies will run services. Worse still, the bill gives the health sector the task of making sure the NHS abides by EU competition law, making it almost impossible for services to return in-house once they have been put out to tender. It is effectively a one-way ticket to NHS privatisation.
The risk of proceeding with these reforms is substantial. The NHS is already making unprecedented savings of £20bn over the next four years. Job losses, cuts and disruption to services will increase and become highly visible. Forcing the NHS into the biggest reform package in its history is a sizeable risk. Core parts of the proposed changes, like GP commissioning, are untested, and will be fraught with implementation difficulties.
With the formation of up to 500 GP consortia, all free to set their own priorities, a highly visible postcode lottery will develop. The financial success of each GP consortia will also affect the service that their patients receive. It will influence the type of care provided and how long it lasts. Some patients needing hospital treatment may, because of financial restraints, find waiting lists extended into the next financial year.
Providing more choice to patients has done very little to improve quality. Most people when offered a choice opt for their local hospital. Choice may be important, but for patients it comes below the quality, speed and accessibility of care.
GP commissioning is central to the reforms yet it is highly controversial and will be very difficult to implement. It could easily be undermined by a lack of expertise to fulfil the commissioning role amongst GPs. Any gap would inevitably be filled by private firms. These reforms would therefore result in the increasing privatisation of our health service.
The proposals also introduce a potential conflict of interest for GPs in advising their patients, as they would become both service provider and service purchaser.
Two thirds of GPs oppose the plans to force practices to join commissioning consortia, and almost all say that the profession should have been consulted in advance. The BMA has said that it will put ‘absolutely everything’ on the table including strike action when it determines the medical profession’s response to the Government’s NHS reforms at a meeting this week. Doctors’ leaders have set out a series of demands to ministers they say must be met before they can support the health bill, including amendments to ensure GPs are free to co-operate with hospital specialists and to scrap moves for providers to compete on price. And why is there no pilot of the scheme? The NHS has undergone major restructuring 15 times in the past 30 years, with little or no evidence that these reorganisations have made any improvements.
The 'any willing provider' approach in an expanded NHS market will see many new entrants, including international corporations, competing to treat NHS patients. There is a proven threat to quality of care from involving profit-led companies in the provision of healthcare. Private healthcare providers, for example, have been known to “cherry-pick” the less complex patients. The quality of work done in private treatment centres has been seriously criticised by NHS surgeons and their professional bodies. The danger is that these private companies will inevitably put profit before patients.
There is also a real danger of a two-tier service developing. While providers will compete for contracts in more affluent areas, poorer communities could struggle to sustain a comprehensive range of healthcare of a comparable standard. The increasing trend to allow personal top-ups to the funding of NHS care will widen the divisions between those who can afford to pay and those who can't.
This is what markets do. They create hierarchies of service, not universal excellence.
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