Clegg’s ‘NHS rebellion’ is playfighting if no change on competition

Dominic Browne looks at the key compromises Clegg has to achieve on the health bill before he can anything to boast about.

Nick Clegg and David Cameron

Much fuss was made this morning over Nick Clegg’s rebellion over the NHS reforms, as reported in the national newspapers.

However, the Liberal Democrat leader seems to be kicking up a fuss by focusing on GP Consortia which – as Andrew Lansley has said – have already been introduced across much of the country. Indeed as the right-wing press have reported, this could be portrayed as Clegg trying to steal credit for Cameron’s compromises.

However, nowhere in the reporting is it mentioned that Clegg is asking for concessions on competition and the role of prospective regulator; Monitor. This is one of the BMA’s key concerns over the reforms. It points out that:

• Clause 52 of the Bill states that “the main duty of Monitor in exercising its functions is to protect and promote the interests of people who use health care services —
(a) by promoting competition where appropriate, and
(b) through regulation where necessary”
Clause 60 of the Bill gives Monitor the same powers the OFT has under the 1998 Competition Act, following the model used in a number of privatised industries, including gas, telecommunications, electricity and water.

Dr David Bennett, the newly appointed chairman of Monitor, has already expressed his enthusiasm for such a set up, stating that the privatisation of British utilities produced benefits that could replicated in the NHS.

In a direct rejection of this idea the BMA have stated it “does not believe that healthcare should be treated in the same way as the privatised telecommunications and energy industries”. They detailed their concerns over the issue:

• Monitor will focus more on enforcing competition in health services than on the continued provision of efficient and effective healthcare

• The pressure to apply competition rules could divert providers and commissioners from their key task of designing and maintaining high-quality patient care. There is a risk that it will become difficult or impossible for commissioners and providers to operate in the best interests of patients, for fear of being open to frequent and costly legal challenges for anti-competitive practices

• Local health services and patient care may become fragmented and / or destabilised if arrangements between local providers and commissioners that have worked well in the past are deemed anticompetitive by Monitor

• Existing NHS services could be at risk of closure, despite being popular with patients and delivering high quality care

• The partnership model of care provided by GPs and hospitals doctors could be disrupted and replaced by the inevitable instability of competitive tendering for health services

The BMA is committed to an NHS that cares for patients through co-operation, not competition. Monitor’s key task must be to maintain access to high quality patient care, rather than promoting competition. Only by removing the duty on Monitor to promote competition can it be ensured that commissioners and providers are given the freedom to operate in the best interests of their patients. The BMA is therefore seeking an amendment to Clause 52, removing Monitor’s duty to promote competition. Moves in the Bill to provide Monitor with concurrent powers with the Office of Fair Trading to apply the Competition Act 1998, following the model used in various utility industries, are worrying. The BMA is seeking the removal of Clause 60.

The Royal College of General Practitioners have also attacked the reforms in the papers today and have outlines similar concerns to the BMA’s. Unless Clegg takes action on competition, and not just GP consortia, this rebellion is just playfighting.

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