Dr. Ron Singer, a practising doctor and member of the Medical Practitioners Union - a part of Unite - on David Cameron's speech on the NHS reforms last week.
David Cameron’s “personal guarantees” on the NHS were presented as a significant and welcome shift in government health policy. But I am a doctor, with decades of experience in caring for NHS patients, and I cannot agree.
And for those Lib Dem members anxious to understand what these “pledges” mean in terms of their conference policy, the answer is a short one: nothing. Some of the “guarantees” the PM offered were not made at all, while others just restated existing policy.
Worse still, far from being welcome concessions, the substantive changes that were confirmed threaten to make the government’s health policy even more toxic.
• Promises to ensure no privatisation mean no such thing. There never was a plan to “sell off” the NHS; instead the plan is to make it extremely easy for the private sector to take over large parts of the service.
• The PM has defended plans to allow private companies to take over NHS functions and compete directly with the NHS.
• There was no pledge to restore the Secretary of State’s duty to provide a comprehensive health service. Instead the speech defended existing proposals to allow local GP consortia to decide what treatments were available in their area, allowing a postcode lottery of care.
• The much-hyped promise on waiting times was no more than to keep the existing text of the NHS Constitution; there was never any proposal to change this in the first place.
• Despite the implication that the new health market enforcer, Monitor, would have its duty to promote competition changed, the PM simply re-stated the existing text of the Bill. So competition will have to be ‘cooperative’ – but not a word on putting care first.
Other parts of the prime minister’s speech give cause for further alarm:
• The pledge that Monitor will enforce “a level playing field” restates existing government plans to subsidise private providers by paying them a different NHS tariff. So the government will use our money to compensate private for their higher costs, like corporation tax.
They will effectively claim back their tax (and other costs) through a higher tariff – at our expense.
• A pledge to put one nurse and one consultant on each consortia board is muddled. It ignores the huge range of specialisms within medicine and nursing, excluding the other health professions making up around half of the clinical workforce and currently involved in decision making.
• “Clinical senates” simply add to costs and complexity while replicating structures that already exist. GPs are already complaining that the new system is creating a whole new bureaucracy.
• The abolition of the 2013 deadline for consortia to take over commissioning gives the appearance of flexibility but causes more problems – it’s simply another layer to the postcode lottery.
And still missing is a pledge that the Secretary of State will be accountable to Parliament – and to us – for the service our taxes fund. Far from being a step in the right direction, the prime minister’s announcements do nothing to address the criticisms of health professionals.
We will be charged with implementing these changes; but if we do not have the confidence that they will work, then they must go – and for the Liberal Democrats determined to stick to their NHS promises, they must give even greater cause for alarm.
Next week, when Professor Field’s report is published, we look forward to a brief conclusion: scrap the bill and start again.
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