Holding the Liberal Democrats to account at their Spring Conference.

“There can never be a better time for a Beveridge”

Despite widespread opposition to the bill from nearly all NHS stakeholders , the Liberal Democrats are still propping up the Health and Social Care Bill. Considering the following public statements from leading professional bodies, this political postitioning is nothing short of disgraceful.

Professor Terence Stephenson, President of the Royal College of Paediatrics and Child Health (RCPCH):

“It is clear that a substantial majority of our voting members believe that the Health and Social Care Bill carries risk for children and young people”

This message was echoed by 154 prominent paediatricians in a letter to the Lancet, which stated:

Professor Lyndsey Davies, President of the UK Faculty of Public Health (UKFPH):

“It is clear that the majority of our members now believe that the Health and Social Care Bill, if passed, will damage the NHS and the health of people in England”

Professor Finbarr C Martin, President, British Geriatrics Society (BGS)

“We are concerned that the Bill does not support the changes necessary to provide integrated, high quality consistent care for our ageing population and has a serious risk of undermining the progress made in recent years”

Dr Clare Gerada, Chair of the Royal College of GPs

“GPs don’t think the bill is going to create a patient led NHS, they don’t think it is going to increase autonomy, they don’t think it is going to improve patient care, and they don’t think it is going to improve healthcare inequalities”

It is clear that professional bodies think that the bill will damage the NHS and harm patient care. It is therefore simply unacceptable that politicians continue to support this bill. They are clearly putting politics before patients. Even Baroness Williams has damaged her own reputation on the NHS. She is a friend of the NHS no longer.

However, it is somewhat reassuring that at least some grassroots Liberal Democrats are calling on their party to withdraw their support for the Health and Social Care Bill. Dr Charles West, a GP and Liberal Democrat for Shrewsbury and Atcham, has launched a petition for this purpose, and has also put an important emergency motion on the Health Bill forward for debate at the Liberal Democrat Spring Conference.

The Liberal Democrats have a proud heritage of supporting public services and social welfare through state intervention. This is very much based on the work of famous Liberals like William Beveridge and John Maynard Keynes. However, more recently, the Liberal Democrat Party has been consumed by the free-market neoliberal ideology of Orange Book liberals, who include Nick Clegg, Vince Cable and David Laws. I thoroughly recommend this article by Simon Kovar, which goes into some detail on this subject. Some of their philosophy marries very well modern conservatism, and the fact they formed a coalition Government with the Conservatives is not surprising in the slightest. This is an excellent and prescient article from Tribune magazine on this topic.       

The centre left of the party, which represents the majority of grassroots LibDems has been decimated by the centre right Orange Bookers. The Liberal Democrat attack on the NHS is therefore completely understandable in political terms. The Orange Book, which was published in 2004 notoriously called for a social insurance system, with private providers to replace public provision of NHS care. I’ve described this previously in some more detail in this Hospital Doctor blog

Tellingly, a younger Nick Clegg in 2005 was quoted in the Independent as saying

"One very, very important point - I think breaking up the NHS is exactly what you do need to do to make it a more responsive service."

On a more positive note, the progressive wing of the Liberal Democrats has reformed the Beveridge Group . Their website states that:

“The revival of the Beveridge Group has been stimulated by a growing awareness that there is no fundamental debate about the role of public services within the coalition”

Key members include Tim Farron (President of the LibDems), Andrew George, John Pugh, Simon Hughes, Norman Baker and Alistair Carmichael.

It is therefore of vital importance for the NHS that this group sticks to its longstanding and proud principles and protects the NHS by coming out against the bill. Andrew George has done this already and Tim Farron has been critical of the bill. However, the group needs to have the courage to go further. The Conference must support Dr Charles West’s motion and not water it down.

The “Bevan-Beveridge Run” aims to raise awareness of the dangers of the bill and simulate debate with the Liberal Democrat ranks about where their loyalties lie. Do they support the NHS or do they support it’s destruction by the Orange Bookers? It’s time to decide

In our view:

“There can never be a better time for a Beveridge”

Bevan's Run 2 - "The Bevan-Beveridge run"

Middlesbrough to Newcastle, 42 miles in under 17hours, March 9th-10th, 2012

On Friday 9^th of March, Dr David Wilson and myself will be heading off on another long distance run to continue our protests against the Health and Social Care Bill. This time we are aiming our protest at the Liberal Democrat Spring Conference in Newcastle, by running 42 miles in under 17 hours (Middlesbrough to Newcastle).

We will be starting our run at approximately 6pm outside our place of work, James Cook University Hospital, in Middlesbrough. We will be running to Durham, where we will bed down for a few hours, before getting up and starting the second leg at 7am to head to Wesley Square, Newcastle, to join the Keep Our NHS Public rally at 11am. There will then be a march to Baltic Square, Gateshead for a 12.30pm demo against the LibDems involvement in the dismantling of the NHS.

Details of the rally are HERE, so please come along to demonstrate against the NHS reforms   

Royal College of Radiologists Extraordinary General Meeting

RCR EGM 16th February 2012

I made following speech at the RCR EGM to support the motion below.
The motion was supported in full. The full results can be found here.
(Please note the number of abstentions for the Council's own motion)

That this meeting:

(a) welcomes the RCR statement that it cannot support, and must continue to oppose the passage of the Health and Social Care Bill in its current form;

(b) considers that the Health and Social Care Bill, if passed, will damage the NHS and widen healthcare inequalities, with detrimental effects on patient care in England;

(c) cannot support the Health and Social Care Bill without seeing the NHS reform Risk Register
(d) calls upon the RCR to publicly call for withdrawal of the Health and Social Care Bill;
(e) calls upon the RCR to seek an alliance with the BMA, RCN, RCM and other willing Royal Colleges and NHS stakeholder organisations to collectively call for the withdrawal of the Health and Social Care Bill.

(f) calls upon the RCR to hold a joint press conference with the BMA and other willing Royal Colleges and NHS stakeholder organisations, to make a joint public statement calling for the bill to be withdrawn

Speech

"I would like to thank Council and the President for calling this important meeting

I am co-chair of the NHS Consultants’ Association, a member of BMA Council and the Political Board.

This is not a party political issue. I campaigned against New Labour’s market based NHS reforms because I believe that a publicly funded, publicly provided, and publically accountable NHS is the most cost effective and equitable way of delivering healthcare to our population.

This is about defending the NHS from increasing marketisation and privatisation, which will inevitably undermine the founding principles of the NHS, leading to increasing healthcare inequalities, reduced access to care, increased healthcare expenditure, and the undermining of medical professionalism and the doctor-patient relationship

I don’t accept and I don’t think anyone accepts the status quo. I think we all realise that the NHS has problems and we would all agree that the NHS needs to continuously adapt, change and improve to meet the current and future health needs of the nation. But this has always been the case and will continue to be so. It is part of the duty of being a doctor.

However, we will hear today why the Health and Social Care Bill is not the answer to the problems of the NHS and will in fact make things worse not better. We’ll also hear why the case for such a radical change to the NHS has not been made.

Not only is the bill 3 times longer than the original bill and littered with 100s of new amendments, there is widespread recognition that something is deeply wrong with this bill. The level of opposition is unprecedented and ranges from the usual suspects of the unions, right through to members of the Cabinet of the Government. There are at least 23 professional groups in opposition including frontline staff as well as NHS managers. The highly critical joint editorial from the BMJ, HSJ and Nursing Times was a watershed moment.

Surveys of the RCGP have shown that the vast majority want the bill withdrawn.

Clare Gerada has stated:

“GPs don’t think the bill is going to create a patient led NHS, they don’t think it is going to increase autonomy, they don’t think it is going to improve patient care, and they don’t think it is going to improve healthcare inequalities”

Professor Lyndsey Davies, Chair of the UK FPH, which has just publicly called for withdrawal of the bill, has stated that: “the majority of our members now believe that the Health and Social Care Bill, if passed, will damage the NHS and the health of people in England”

There is also great confusion about what the bill actually means. Hamish Meldrum said it was “Hopelessly complex”. The new Chair of the NHSCB, Professor Malcolm Grant, who is a lawyer, said it was “unintelligible”.

However, experts in constitutional, public and commercial law, as well as health policy have written extensively about the bill and published their analyses in major medical journals to explain what the core underlying aim are.

There is little doubt that the intention of this bill is to denationalise the English NHS, by removing the duties and powers of the SoS of state to provide a comprehensive service.

Thus the crossbencher Lord Owen has called this the “Secratary of State abdication bill”. This explains the furore around Clause one and related clauses on the Secretary of State’s duties and powers. This is a red line he will not give up. Why not return it to the original 2006 Act wording?

In addition the bill abolishes the previous planning structures of the NHS, with creation of a regulated external market in healthcare, with public provision of healthcare increasing being replaced by private provision (through the AQP policy), driven by a competitive market. 

The Public Interest lawyer, Peter Roderick has stated:

 “The fundamental legal basis for the NHS, which was put in place in 1946, will be removed by the Government’s Health and Social Care Bill.”

He goes on to state that:

“a direct line of logic can now be traced in the Bill, which leads to the unavoidable conclusion that if the Bill was to be enacted, the legal stage would be set for private companies to be entitled to run much of the NHS and for market forces to determine the way many health services are provided."

The number of services provided by the NHS will decline over the next few years and increasing numbers of patients will take out health insurance to widen their coverage. This process will be catalysed by the QIPP efficiency drive as services start to fail and CCGs come under enormous pressure to reduce costs. This will then place enormous financial pressure on FTs, which will need to treat increasing proportions of private patients to stay afloat. This is why Priavte Patient cap is being uplifted to 49%.

Over a 5-10 year period we will see the NHS transform in to a mixed funding system

This will all have detrimental effects on professionalism and professional standards

Markets fundamentally undermine professionalism.

The relationships between medical professionals and patients depend on trust rather than contractual obligations and attempting to reduce the provision of healthcare to economic transactions erodes the intrinsic motivations on which the doctor-patient relationships depend.

This strikes right at the heart of the social contract, which is fundamental to medical practice and professionalism. So it also strikes at the heart of this College. As Professor Kenneth Arrow recently stated about markets in healthcare “one problem we have now, is an erosion of professional standards”

It is therefore no coincidence that the American medical profession lost public support faster than any other profession during the rapid marketisation of the US healthcare system in the 1970/80s

Doctors intrinsically want to work collaboratively. A MORI survey of doctors showed that competition was the biggest problem they had with the reforms.

This clearly leaves Mr Lansley with a huge problem with his reform agenda because as he stated in a speech to the NHS confederation: “the first guiding principle is this: maximise competition…... which is the primary objective”

Another issue is that clinical leadership and clinical followership are crucial to successful healthcare reform. Mr Lansley has lost the healthcare professions. The reforms are doomed to failure

The Colleges should also be very concerned about the effect of market reforms on medical training and standards. The profession has already suffered the Modernising Medical Careers (MMC) debacle, which can in part be explained by the influence of market based policies. MMC utilised a competency based tick box approach to training and it is important to note that Competency Based Training (CBT) originated in the 1980s and was a politically driven movement with the aim of making national workforces more competitive in the global markets by focusing on discrete technical skills with an emphasis on outputs, performance assessment, and value for money. However, the professional skills of doctors are much more based on tactic and experiential knowledge.

Sir John Tooke’s report on MMC, Aspiring to Excellence, clearly highlighted MMC’s emphasis on achieving minimal standards rather than excellence35. A prescient editorial in the British Journal of General Practice described how the proposals for the establishment of PMETB:

“… are clearly intended to enable the Secretary of State of the day to direct that standards can be lowered to meet the manpower demands of the NHS”

I will leave you with a quote from Arnold Relman, Emeritus Professor of Medicine of Harvard Medical School, and former editor of the New England Journal of Medicine:

“Medical professionalism cannot survive in the current commercialized health care market. The continued privatization of health care and the continued prevalence and intrusion of market forces in the practice of medicine will not only bankrupt the health care system, but also will inevitably undermine the ethical foundations of medical practice and dissolve the moral precepts that have historically defined the medical profession.”

.

In summary,

This bill is flawed. It lacks a democratic mandate. The case for such radical change has not been made. NHS productivity is increasing and patient satisfaction is at the highest levels ever recorded. Bureaucracy will be increased, not decreased. The bill lacks professional and public support (YouGov poll). We haven’t seen the risk register. It is unamendable due to the mutually reinforcing nature of the market policies, which are therefore the Coalition’s red line in the sands.

Costs will go up and not down. The service will be fragmented and the transactional nature of the new healthcare market will undermine medical professionalism and the doctor patient relationship.

The latest amendments do little address the fundamental underlying structural changes of the bill that will undermine the NHS

For these reasons, the College should continue to oppose the bill, but more that that the college should join with other professional organisations and call for withdrawal of the bill 

The fellows are ready to get behind the College to back them every step of the way. Please vote for the motion in all it parts to protect the NHS and the future interests of our fellows."

Royal College of Radiologists Extraordinary General Meeting

RCR EGM 16th February 2012

I made following speech at the RCR EGM to support the motion below.
The motion was supported in full. The full results can be found here.
(Please note the number of abstentions for the Council's own motion)

That this meeting:

(a) welcomes the RCR statement that it cannot support, and must continue to oppose the passage of the Health and Social Care Bill in its current form;

(b) considers that the Health and Social Care Bill, if passed, will damage the NHS and widen healthcare inequalities, with detrimental effects on patient care in England;

(c) cannot support the Health and Social Care Bill without seeing the NHS reform Risk Register
(d) calls upon the RCR to publicly call for withdrawal of the Health and Social Care Bill;
(e) calls upon the RCR to seek an alliance with the BMA, RCN, RCM and other willing Royal Colleges and NHS stakeholder organisations to collectively call for the withdrawal of the Health and Social Care Bill.

(f) calls upon the RCR to hold a joint press conference with the BMA and other willing Royal Colleges and NHS stakeholder organisations, to make a joint public statement calling for the bill to be withdrawn

Speech

"I would like to thank Council and the President for calling this important meeting

I am co-chair of the NHS Consultants’ Association, a member of BMA Council and the Political Board.

This is not a party political issue. I campaigned against New Labour’s market based NHS reforms because I believe that a publicly funded, publicly provided, and publically accountable NHS is the most cost effective and equitable way of delivering healthcare to our population.

This is about defending the NHS from increasing marketisation and privatisation, which will inevitably undermine the founding principles of the NHS, leading to increasing healthcare inequalities, reduced access to care, increased healthcare expenditure, and the undermining of medical professionalism and the doctor-patient relationship

I don’t accept and I don’t think anyone accepts the status quo. I think we all realise that the NHS has problems and we would all agree that the NHS needs to continuously adapt, change and improve to meet the current and future health needs of the nation. But this has always been the case and will continue to be so. It is part of the duty of being a doctor.

However, we will hear today why the Health and Social Care Bill is not the answer to the problems of the NHS and will in fact make things worse not better. We’ll also hear why the case for such a radical change to the NHS has not been made.

Not only is the bill 3 times longer than the original bill and littered with 100s of new amendments, there is widespread recognition that something is deeply wrong with this bill. The level of opposition is unprecedented and ranges from the usual suspects of the unions, right through to members of the Cabinet of the Government. There are at least 23 professional groups in opposition including frontline staff as well as NHS managers. The highly critical joint editorial from the BMJ, HSJ and Nursing Times was a watershed moment.

Surveys of the RCGP have shown that the vast majority want the bill withdrawn.

Clare Gerada has stated:

“GPs don’t think the bill is going to create a patient led NHS, they don’t think it is going to increase autonomy, they don’t think it is going to improve patient care, and they don’t think it is going to improve healthcare inequalities”

Professor Lyndsey Davies, Chair of the UK FPH, which has just publicly called for withdrawal of the bill, has stated that: “the majority of our members now believe that the Health and Social Care Bill, if passed, will damage the NHS and the health of people in England”

There is also great confusion about what the bill actually means. Hamish Meldrum said it was “Hopelessly complex”. The new Chair of the NHSCB, Professor Malcolm Grant, who is a lawyer, said it was “unintelligible”.

However, experts in constitutional, public and commercial law, as well as health policy have written extensively about the bill and published their analyses in major medical journals to explain what the core underlying aim are.

There is little doubt that the intention of this bill is to denationalise the English NHS, by removing the duties and powers of the SoS of state to provide a comprehensive service.

Thus the crossbencher Lord Owen has called this the “Secratary of State abdication bill”. This explains the furore around Clause one and related clauses on the Secretary of State’s duties and powers. This is a red line he will not give up. Why not return it to the original 2006 Act wording?

In addition the bill abolishes the previous planning structures of the NHS, with creation of a regulated external market in healthcare, with public provision of healthcare increasing being replaced by private provision (through the AQP policy), driven by a competitive market.  

The Public Interest lawyer, Peter Roderick has stated:

 “The fundamental legal basis for the NHS, which was put in place in 1946, will be removed by the Government’s Health and Social Care Bill.”

He goes on to state that:

“a direct line of logic can now be traced in the Bill, which leads to the unavoidable conclusion that if the Bill was to be enacted, the legal stage would be set for private companies to be entitled to run much of the NHS and for market forces to determine the way many health services are provided."

The number of services provided by the NHS will decline over the next few years and increasing numbers of patients will take out health insurance to widen their coverage. This process will be catalysed by the QIPP efficiency drive as services start to fail and CCGs come under enormous pressure to reduce costs. This will then place enormous financial pressure on FTs, which will need to treat increasing proportions of private patients to stay afloat. This is why Priavte Patient cap is being uplifted to 49%.

Over a 5-10 year period we will see the NHS transform in to a mixed funding system

This will all have detrimental effects on professionalism and professional standards

Markets fundamentally undermine professionalism.

The relationships between medical professionals and patients depend on trust rather than contractual obligations and attempting to reduce the provision of healthcare to economic transactions erodes the intrinsic motivations on which the doctor-patient relationships depend.

This strikes right at the heart of the social contract, which is fundamental to medical practice and professionalism. So it also strikes at the heart of this College. As Professor Kenneth Arrow recently stated about markets in healthcare “one problem we have now, is an erosion of professional standards”

It is therefore no coincidence that the American medical profession lost public support faster than any other profession during the rapid marketisation of the US healthcare system in the 1970/80s

Doctors intrinsically want to work collaboratively. A MORI survey of doctors showed that competition was the biggest problem they had with the reforms.

This clearly leaves Mr Lansley with a huge problem with his reform agenda because as he stated in a speech to the NHS confederation: “the first guiding principle is this: maximise competition…... which is the primary objective”

Another issue is that clinical leadership and clinical followership are crucial to successful healthcare reform. Mr Lansley has lost the healthcare professions. The reforms are doomed to failure

The Colleges should also be very concerned about the effect of market reforms on medical training and standards. The profession has already suffered the Modernising Medical Careers (MMC) debacle, which can in part be explained by the influence of market based policies. MMC utilised a competency based tick box approach to training and it is important to note that Competency Based Training (CBT) originated in the 1980s and was a politically driven movement with the aim of making national workforces more competitive in the global markets by focusing on discrete technical skills with an emphasis on outputs, performance assessment, and value for money. However, the professional skills of doctors are much more based on tactic and experiential knowledge.

Sir John Tooke’s report on MMC, Aspiring to Excellence, clearly highlighted MMC’s emphasis on achieving minimal standards rather than excellence35. A prescient editorial in the British Journal of General Practice described how the proposals for the establishment of PMETB:

“… are clearly intended to enable the Secretary of State of the day to direct that standards can be lowered to meet the manpower demands of the NHS”

I will leave you with a quote from Arnold Relman, Emeritus Professor of Medicine of Harvard Medical School, and former editor of the New England Journal of Medicine:

“Medical professionalism cannot survive in the current commercialized health care market. The continued privatization of health care and the continued prevalence and intrusion of market forces in the practice of medicine will not only bankrupt the health care system, but also will inevitably undermine the ethical foundations of medical practice and dissolve the moral precepts that have historically defined the medical profession.”

.

In summary,

This bill is flawed. It lacks a democratic mandate. The case for such radical change has not been made. NHS productivity is increasing and patient satisfaction is at the highest levels ever recorded. Bureaucracy will be increased, not decreased. The bill lacks professional and public support (YouGov poll). We haven’t seen the risk register. It is unamendable due to the mutually reinforcing nature of the market policies, which are therefore the Coalition’s red line in the sands.

Costs will go up and not down. The service will be fragmented and the transactional nature of the new healthcare market will undermine medical professionalism and the doctor patient relationship.

The latest amendments do little address the fundamental underlying structural changes of the bill that will undermine the NHS

For these reasons, the College should continue to oppose the bill, but more that that the college should join with other professional organisations and call for withdrawal of the bill 

The fellows are ready to get behind the College to back them every step of the way. Please vote for the motion in all it parts to protect the NHS and the future interests of our fellows."

“When” becomes “If”. The bill can be defeated with united professional and public opposition

"When" becomes "if"

Something remarkable is happening in the political discourse surrounding the parliamentary passage of Health and Social Care Bill. Suddenly the language is changing from "when" the bill is enacted to "if" the bill is enacted. A good case in point can be found in Professor Paul Corrigan’s latest blog. He is a respected NHS commentator and a former health policy advisor to Tony Blair and remains in close contact with the corridors of power. He has his finger on the pulse and is now using the “if” word about the bill. Considering the parliamentary maths is so in favour of passage of the bill, this truly is an incredible sea change in opinion. He is not the only one to be saying their, either, with many commentators going further and actually calling for the bill to be dropped . Only a few months ago, I was being repeatedly told that this was impossibility.

The NHS is now once again a big political football and it is clear that the Tories have retoxified themselves on this issue.

A new YouGov poll highlighted in the Guardian, reveals the extent of the damage being inflicted on the Tories and LibDems by the controversial bill. It shows that 62% of voters do not trust ministers on the health service, nearly double the 34% who say they do. Among Tory voters, nearly a quarter (24%) said they did not now trust their own government to handle the NHS, a belief shared by 59% of Liberal Democrat voters. So the LibDems are also toxic now.

In addition another YouGov poll shows 50 per cent of people reckon the Health Bill should be dropped, against 23 per cent who reckon it should stay. Some of the fieldwork was done before Friday's blow-up, when three cabinet ministers supported an editorial on the influential Conservative Home website, describing the NHS bill as "potentially fatal to the Conservative party's electoral prospects".

Another story in the Daily Mail has suggested half of the cabinet were in despair and this was a poll tax moment. I actually predicted this last year in a piece for Hospital Doctor.

This really is crunchtime for the government.  However, despite a rather vicious and brutal Number 10 briefing against Mr Lansley, David Cameron has now backed him 100%.  In the Telegraph, Cameron stated:

‘I am at one with Andrew Lansley, the reform programme and the legislation going through parliament’

More interestingly, according to the BBC, Cameron now wants to put choice and competition back at the heart of the reforms.

"Choice, competition and transparency may unsettle some people, but it's these things at the heart of our reform that will lead to the better NHS I care about and our country deserves."

This is despite all the political rhetoric of the last few months about focusing on integrated care after the government said it would accept all the Future Forum recommendations in full, which included rowing back on the pro-competition aspects of the bill. Competition was also the biggest issue to frontline doctors, according to an Ipsos MORI poll. So this apparent change back to pro-competition, pro-market principles appears to suggest that Cameron is taking a much more belligerent approach to forcing the bill through. This may be because he feels that the Tories have now spilt so much blood on this issue, that they might as well gamble and go for a more radical approach in keeping with the original full blooded market principles of the bill. This is interesting from a philosophical point of view, because the pro-marketeers in the Tory party are driven by a neoliberal ideology, which completely rejects the collectivist idea of a NHS. Since the NHS is a
unique example of the collectivist provision of health care in a market society (Rudolph Klein), there is nothing more that they would like to see, than the end of the NHS. This is because collectivism is the enemy of the market (See Neoliberal Ideology – History, Concepts, Policies by Rachel S Turner for an excellent overview). They may feel they have already blown their chances at the next election, so this just might be a way of destroying the NHS as a publicly provided service once and for all, because it likely to be irreversible. This is pure speculation of course, but whatever the real reasons behind Cameron’s decision to plough on, he and his party, along with the Liberal Democrats are in an awful position – a classic Catch 22.

Now that Cameron has made this decision, opponents need to turn up the heat on him and the LibDems as much as possible. A united front from medical professional organisations is a key way to raise the temperature and this is building up nicely with Extraordinary General Meetings of various Colleges, as well as new surveys and ballots. Paul Corrigan’s blog suggested that medical opposition would wane and become untenable, but he has completely failed to acknowledge that the “NHS Spring” also involves lots of other professional groups who openly oppose the Health and Social Care Bill, including the following:

Royal College of Nursing

Royal College of Midwives

Chartered Society of Physiotherapists

Who all signed this open letter with BMA calling for withdrawal of the bill

Community Practioners and Health Vistitors Assocaition CPHVA

NHS Managers – Management in Practice and Institute of Healthcare Management

Allied Health Professionals Federation , which includes the following 12 organisations (120,000 members):

The Society of Chiropodists and Podiatrists (SCP)

The Society and College of Radiographers (SCoR)

The Royal College of Speech and Language Therapists (RCSLT)

The College of Paramedics (COP)

The Chartered Society of Physiotherapy (CSP)

The British Association of Occupational Therapists/ College of Occupational Therapists (BAOT, COT)

The British and Irish Orthoptic Society (BIOS)

The British Association of Prosthetists and Orthotists (BAPO)

The British Dietetic Association (BDA)

The British Association of Drama Therapists (BADT)

The British Association of Art Therapists (BAAT)

The Association of Professional Music Therapists (APMT)

This level of opposition is unprecedented. A joint press conference calling for withdrawal of the bill, with all these groups plus the BMA and willing Royal Colleges would defeat this bill. I believe the Parliamentary maths would be irrelevant in this context. In fact, many healthcare professionals already believe that the bill is so flawed, it would be detrimental to patient care to enact. This is certainly the view of the UK Faculty of Public Health, which issued a press statement calling for withdrawal of the bill and stated that:

“the results of our latest survey of members found that 93% of those responding said that the Health and Social Care Bill, if passed, would damage the NHS and the health of people in England”

“FPH calls on government to withdraw Health and Social Care Bill 'in best interests of everyone's health'”

How on earth can Mr Cameron and his Liberal Democrat allies carry on with this bill and retain any credibility with the health professions, other NHS staff, and with the public?

Mr Cameron must withdraw the bill. In return, he must be allowed an exit strategy to do this.