Last week, David Cameron claimed with astonishing chutzpah but complete lack of evidence that health professionals were on board with the health and social care bill. In fact, a back of the envelope calculation suggests that the number of doctors who actively support it (as opposed to those who have had to get involved with it) is in single figures. Surveys and conference motions show that the public and health professionals have no confidence in the bill and want it scrapped. So why is the legislation going for its third reading next week, with such indecent haste that MPs will hardly have had time to shake the sand from their shoes?
Such is the dislike and distrust of the bill that the campaigning group 38 Degrees easily raised thousands of pounds from the public to pay for legal opinion on key issues in it. The recently published conclusions are essential reading and are completely at odds with the government’s bland reassurances.
They found that the bill does indeed “remove the duty of the secretary of state to provide or secure the provision of health services which has been a common and critical feature of all previous NHS legislation since 1946”. Furthermore, a “hands-off clause” will “severely curtail the secretary of state’s ability to influence the delivery of NHS care to ensure everyone receives the best healthcare possible”. They conclude the government can now wash its hands of the NHS, while the likelihood of a postcode lottery increases and local accountability decreases.
They also conclude that the bill “will increase competition within the NHS at the expense of collaboration and integration and/or make it almost inevitable that UK and EU competition law will apply as if it were a utility like gas or telecoms”. So despite the coalition’s repeated denials, this legal opinion believes that “these plans will lead to a system geared heavily in favour of private companies”.
The government has lied about it, and the public and profession don’t want it – so why are we still threatened with it? One answer may be that while grassroots doctors have been clear about their antipathy to it we have been failed thus far by our leaders who have been keeping a low profile. Their voice, which could be immensely influential, has been missing.
With the honourable exception of the Royal College of General Practitioners, we’ve heard remarkably little from the royal colleges of medicine thus far. This is disappointing, given their remit is to oversee quality, standards, teaching and training, all of which are under threat from this bill. They have undoubtedly submitted written responses to the government’s proposals but attempting to negotiate and influence in this way presupposes politicians who will listen. The government isn’t interested in professional advice unless we toe the line. Andrew Lansley didn’t bother to meet Sir Roger Boyle, the highly effective national director for heart disease and stroke, until he tried to sack him for speaking out of turn.
Also keeping well below the parapet is the BMA, which has been given a clear mandate from its members to campaign for the bill to be withdrawn. It continues to hedge its bets, still lobbying to obtain amendments when it is clear that no amendment could possibly alter the nature of a bill that has privatisation stamped through its core.
Analysis and lobbying are fine, but when they fail it is time for action. They have manifestly failed, with the “amended” bill still a recipe for privatisation. The bill is already on its knees, with opposition gathering both inside and outside parliament and the major health unions campaigning against it. We now need strong medical leadership to issue a joint statement which would deliver the coup de grace. They have the power, the authority and the mandate. What are they waiting for?
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