“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.