NHS reform: ‘Yes, but this way will harm those who need it’

When the White Paper was published last year my immediate response was: “These are extraordinary changes so they must have extraordinary justification.”

The biggest changes to the structure of the NHS in its 60-year history, the conversion of a public service into a quasi-regulated market and the abandonment of the duty of the Secretary of State for Health to provide healthcare services to the nation ought to have had some pretty extraordinary justification.

But it did not and so, six months later, the Government – under mounting pressure to explain what was so dreadfully wrong that it required such a radical overhaul – came up with some very dubious statistics about heart attack and cancer survival rates. These were very quickly rubbished by everyone who bothered to examine them, including the King’s Fund and the British Medical Association.

The BMA were so concerned about the reforms that they held their first special representative meeting in 20 years and passed motion after motion condemning almost every aspect of the Health and Social Care Bill including one stating: “This meeting deplores the Government’s use of misleading and inaccurate information to denigrate the NHS and to justify the Health and Social Care Bill reforms.”

The Government is making the deepest and most sustained cuts to funding in the history of the NHS.

The Health Bill creates an artificial division between GPs and the rest of the medical profession by giving most of the NHS budget to GPs and calling us “purchasers” or “commissioners” and then calling the others “providers” and “liberating” them to compete in a competitive healthcare market with private companies.

NHS hospitals are woefully unprepared to compete for patients like this. Private providers on the other hand, include major national and international corporations with years of experience of negotiating the marketplace. As Adrian Fawcett, CEO of the largest private hospital group in the UK – General Healthcare Group (GHG) – said: “We are entering a new, exciting era, driven by the forthcoming healthcare reform that will ultimately change, to our benefit, the landscape in which we operate.”

The Government hired management consultants McKinsey to find out how much money the NHS could save. This deeply suspect assessment came up with a figure of £20bn, so now the Government is making the deepest and most sustained cuts to funding in the history of the NHS.

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Markets create winners and losers and so providers, including NHS hospitals, will be amongst the losers and will go bust and be forced to close or will merge or be taken over, not because my patients don’t need them, but because they cannot compete successfully in a competitive market.

Just as NHS hospitals are unprepared, GPs have had no training for this and the management that we depend on has disappeared almost overnight with the abolition of Primary Care Trusts, without Parliamentary approval on 1 April.

Lacking expertise, many GPs are already paying private health insurance companies like United Health to do their commissioning work for them. Commissioning organizations are saving money by rationing services and blocking GP referrals.

All of this goes completely against the founding principles of the NHS, which is to provide an integrated, comprehensive health service for the nation. The Health Bill will create a dis-integrated, postcode-lottery of competing healthcare markets.

In a few years’ time, assuming the Bill is passed, I can imagine the future for my patients. Because of the cuts, several unprofitable departments in the local hospital will have closed. The services will hopefully be available elsewhere, but my patients will be forced to travel to unfamiliar and inconvenient places. They will be “allowed” to pay extra to jump queues for treatment, to have side-rooms in hospital or additional care.

Those services that remain free will have long waiting lists and will be severely restricted, for example physiotherapy or psychotherapy will be limited to a handful of sessions with a junior practitioner. Simple procedures can be performed more efficiently and profitably than complex care, so that care for the elderly, home care, psychiatry, and treatment for addiction will be hit hardest because market incentives will divert resources towards the most profitable work. My job as co-ordinator of my patient’s care will be made impossible because of the huge array of different companies involved in looking after my patients.

NHS needs reform

The NHS does need reform. It desperately needs to improve co-ordination of services and collaboration between professionals. GPs, hospital doctors and nurses, public health specialists and social services need to work together to provide comprehensive care for patients without any cherry-picking of services or patients on the grounds of profitability. Markets have no place in the provision of care on the basis of clinical need.

It needs to reduce health inequalities. Having worked in deprived and affluent areas I know that general practice in deprived areas is far more clinically challenging and less financially rewarding. There are serious inequalities in the resources available, the quality of care and the incentives for GPs.

The Government has made an error in assuming that inequalities are not an issue. Proposed funding allocations will widen inequalities and threaten the financial viability of general practice in areas with the greatest health needs.

Efficient care depends on efficient patients and the impact of markets on inefficient patients will result in the Inverse Care Law. The appalling capitulation to alcohol and junk food manufacturers under the guise of public health policy is an indication of the Government’s failure to take seriously the social determinants of health.

The health bill is the project of a Government determined to dismember the public realm and roll back the state to allow public money to be diverted to the private sector. There is no mandate for such changes and there has been no public debate about them. The listening exercise the Government is embarking on is a PR exercise with little possibility of substantive change.

NHS Reform is desperately needed and it can address the major problems the NHS faces, but for the sake of the patients who need the NHS most of all, the health and social care bill needs to be wholly rejected.

Dr Jonathon Tomlinson is an east London GP and is on the steering committee of the Keep Our NHS Public campaign