2 years ago

2 years ago

Below is an email that I posted on the BMA Council Listserver to fellow BMA Directors, exactly 2 years ago (24 hours following the publication of Andrew Lansley’s White Paper – Equity and Excellence: Liberating the NHS.)

It shows that the White Paper was remarkably clear in its objectives, highlighting Lansley’s intentions to aggressively build on New Labour’s market based NHS. This approach was in total contradiction to the wishes of BMA members, who had repeatedly called for market driven polices to be abandoned. No wonder there was such opposition to the reforms from the medical profession. Unfortunately, much of the major opposition came too late in the day to stop the bill being enacted.

The one key thing the White Paper didn’t make clear at the time was that one of Lansley’s key aims was to make his reforms permanent and entrenched. Hence the need for the enormous amount of legislation contained in the Health and Social Care Bill. This is clearly explained in Nick Timmins’ new book – “Never Again”, which is essential reading and available to download for free here

“Dear All,

I’ve just read the White Paper and my mind is made up. In my opinion, it simply cannot be supported by the BMA because it fundamentally promotes the market based system that our membership has rejected at numerous Annual Representative Meetings.

The rhetoric about devolving power to the frontline professionals doesn’t stand up to scrutiny. It is clear that the autonomy of GP Consortia will be severely curtailed in the name of promoting patient and choice and competition to promote the healthcare market.

The evidence for this is very clear in the White Paper:

1.      Commissioners will be free to buy services from any willing provider; and providers will compete to provide services .

2.      GP consortia will have a high level of freedom; but in return they will be accountable to the NHS Commissioning Board for managing public funds. In future, the NHS Commissioning Board will have a key role in promoting and extending choice and control. The Secretary of State will hold the Commissioning Board to account on delivering improvements in choice and patient involvement, and in maintaining financial control.

3.      GP consortia will align clinical decisions in general practice with the financial consequences of those decisions

4.      One of the functions of the NHS Commissioning board will be to promote personalisation and extend patient choice of what, where and who, including personal health budgets

5.      GP consortia will need to have sufficient freedoms to use resources in ways that achieve the best and most cost-efficient outcomes for patients. Monitor and the NHS Commissioning Board will ensure that commissioning decisions are fair and transparent, and will promote competition.

6.      In General Practice, the Department will seek over time to establish a single contractual and funding model to promote quality improvement, deliver fairness for all practices, support free patient choice, and remove unnecessary barriers to new provision

7.      It has remained the case for several years that just under half of patients recall that their GP has offered them choice. The Department will increase that significantly. We will explore with the profession and patient groups how we can make rapid progress towards this goal

8.      Role of Monitor: Promoting competition, to ensure that competition works effectively in the interests of patients and taxpayers. Like other sectoral regulators, such as OFCOM and OFGEM, Monitor will have concurrent powers with the Office of Fair Trading to apply competition law to prevent anti-competitive behaviour e.g discriminating in favour of incumbent providers

9.      The NHS Outcomes Framework will be translated into a commissioning outcomes framework for GP consortia, to create powerful incentives for effective commissioning

10.  In addition to NHS Choices, a range of third parties will be encouraged to provide information to support patient choice. Our aim is that people should be able to share their records with third parties, such as support groups for patients, who can help patients understand their records and manage their condition better. We will make it simple for a patient to download their record and pass it, in a standard format, to any organisation of their choice

This is everything that the BMA membership wants us to oppose. We simply cannot support it in any shape or form if we take BMA policy seriously. It would make a complete mockery of our campaign. It has far worse potential consequences for the NHS than Working for Patients ever did. This in turn will have profound consequences for the BMA.

Once again, I would like to remind everyone that during the rampant commercialisation of the US healthcare system in the 1980s, "The American medical profession lost public support faster than any other profession" (Blendon R, JAMA)

The only issue for me is what strategy we use to oppose the White Paper.

In view of the above information from the White Paper, do any Council members still seriously believe we should be working with Government to support these policies? If so, then can you please explain how that can be in keeping with BMA policy and the LAON (Look After Our NHS) campaign?

Best wishes,

Clive”