Why Mr Cameron and Mr Lansley cannot be trusted to look after the NHS

Why Mr Cameron and Mr Lansley cannot be trusted to look after the NHS

The Prime Minister takes ultimate responsibility for Government policy and hence ultimate responsibility for looking after the NHS. In fact, Mr Cameron has clearly stated his commitment to the NHS on several occasions. In 2009, in a speech in Bolton, Mr Cameron claimed the NHS was safe under the Tories.

However, in the same speech he also stated that:

“Only a stable, transparent and pro-competitive framework will attract the independent sector to invest in and expand the capacity of the NHS”

''By reducing political risk, we will open up the opportunity for any willing provider to supply care to NHS patients, accepting commercial risk, at NHS prices or less and at the right quality standards.''

Mr Cameron also said that greater competition within the NHS was the key to enhanced patient choice

These statements clearly show the underlying ideology that has been driving Mr Cameron and Mr Lansley – a competitive healthcare market with price competition. We have clearly seen this in the White Paper and it will still be part of the legislation, despite all the rhethoric for "integrated" care (with its many potential meanings). The fact remains that all the tools are in place for a competitve external economic market (a third of the bill legislates for this)

All the key levers are in place to make this happen. All the suggestions from the Future Forum has done nothing to address the key market levers and reduce the risk of increasing marketisation and privatisation:

1.      Patient choice to drive,

2.      competition between a plurality of providers through the Any Qualified Provider policy (which aims to introduce private sector companies)

3.      Payment by results (mony follows patients)

4.      Patient held budgets (increases consumersist approach for market)

5.      Price competition – yes it is back, despite the claims otherwise.

6.      “Abdication” of Secretary of State’s duties and responsibilities to provide comprehensive healthcare services to the population.

The fact that price competition (ability to vary pricing/tariffs) is back on the agenda is clear evidence of the pro-market ideology of the coalition. It is a clear indication that Cameron and Lansley are driven by ideology not evidence. In fact, there is widespread recognition that price competition worsens healthcare outcomes. According to Zack Cooper from the London School of Economics: “Every shred of evidence suggests that price competition in healthcare makes things worse, not better.”

The NHS Confederation also shares this view:

“Economic theory predicts that price competition is likely to lead to declining quality where (as in healthcare) quality is harder to observe than price. Evidence from price competition in the 1990s internal market and in cost constrained markets in the US [United States] confirms this, with falling prices and reduced quality, particularly in harder to observe measures.”

The ideological rather than evidence based nature of the reforms is one of the key reasons why the official BMA policy position is to oppose the bill in its entirety, as well as calling for the bill to be withdrawn. Seven former Presidents of the UK Public Health Faculty agreed with the BMA position in a recent letter to the Times. And the recent RCGP survey showed 98% of GPs want the bill withdrawn and they are supposed to be leading the reforms. Since Chris Ham’s research has concluded that clinical leadership is crucial to successful healthcare reforms, this creates huge problems for Mr Cameron and Mr Lansley. They need to drop the bill right now.

The game is up for Mr Cameron and Mr Lansley. The health professions have lost faith in them a long time ago. We don’t believe the spin and the rhetoric. Here are plenty more examples:

 The 2010 Conservative Election Manifesto: “More than three years ago, David Cameron spelled out his priorities in three letters – NHS”

This refers to “NHS Autonomy and Accountablility. Proposals for legislation” (2007) 

The Introduction written by Cameron and Lansley :

“Improving the NHS is the Conservative Party’s number one priority....this requires an end to the pointless upheavals, politically-motivated cuts, increased bureaucracy and greater centralisation that have taken place under Labour..”

David Cameron’s speech at the 2006 Conservative party conference:

“no more pointless and disruptive reorganisations”. Instead, change would be “driven by the wishes and needs of NHS professionals and patients”. 

The Coalition agreement also specifically pledged to "stop the top-down reorganisations of the NHS that have got in the way of patient care“ (HM Government. The Coalition: Our Programme for Government. Cabinet Office, 2010.)

The Conservative 2007 White Paper would have been in keeping with their claims because of the following statements:

•      4.25 “As part of our commitment to avoid organisational upheaval, we will retain England’s ten SHAs, which will report to the NHS Board.”

•      4.28 “PCTs will remain local commissioning bodies.”

However, the current bill abolishes these structures, so this is clearly a top down reorganisation of the NHS! The coalition have mislead the public

Hence according to Andrew George, Liberal Democrat MP, of the Health Select Committee

Lansley had "Torn up the agreement to resist imposing a top-down re-organisation“

And Zack Cooper of the LSE:

“The new health secretary campaigned on a pledge to eliminate top-down shake ups of the health service.  This white paper contradicts his campaign promise”  

Worse still the estimated costs of reorganisation are £3 billion! (Walshe BMJ)

The bottom line

“The White Paper’s proposals are ideological with little evidential foundation. They represent a decisive step towards privatisation that risks undermining the fundamental equity and efficiency objectives of the NHS. Rather than “liberating the NHS”, these proposals seem to be an exercise in liberating the NHS’s £100 billion budget to commercial enterprises” Lancet Oct 6th 2010
The simple fact is that Mr Cameron and Mr Lansley cannot be trusted on the NHS. Their ideology is neoliberal, with an uncritical faith in markets and the drive for a minimal welfare safety net. It is clear in their policies. This is why they want to privatise large swathes of the NHS. There is no democratice legitimacy for this approach. We must therefore fight them tooth and nail to stop this bill becoming law, and that is why I’ll be in Witney today to tell Mr Cameron’s constituents what he is up to.