The NHS bill is still the catastrophe it was yesterday morning. Those of us who remain incredulous at the research suggesting improvements in care quality appearing in the second half of the 2000s were due to competition, are appalled that the government want to introduce more of into the NHS, and can see a whole range of problems coming from its extension. We believe private providers will take only the patients they want from public healthcare so leaving public providers with only those who are least well. Equally, it’s just about impossible to let comprehensive providers of care financially fail, so competition can’t provide the kind of incentives that its advocates claim. This isn’t a market that can work.
It is ironic that the most recent work from the team from the LSE (from Zack Cooper) that claimed ‘competition saves lives’ has now found that the benefits of expanding private provision are small or even negative – in the New Statesman’s leader this week it was claimed that any credit the government can claim for this work supporting their research has now comprehensively disappeared.
So while there is ever-more impetus against the bill, there is still the political problem of getting the government to step back from the bill and to admit they got it terribly wrong. This has been a struggle so far, and will continue to be.
Then yesterday, the BMA decided that they were going to ballot their membership about action short of a strike on pensions. It’s hard to over-emphasise how much harder this is going to make opposing the NHS bill. This was deeply politically naïve, and shows a remarkable lack of understanding of the history of healthcare in England.
Conservative governments have used two strategies to discredit doctors when protesting against NHS change. Strategy one, which we’ve already seen, is to point at them and say – ‘You opposed the creation of the NHS of course’. Now this is rank hypocrisy as the Conservatives voted against the NHS at its creation as well. The BMA were effectively excluded from the limited consultation that led to the creation of the NHS as Bevan preferred to talk to the Royal Colleges instead (largely because the Royal Colleges could make decisions on behalf of their members without needing a ballot). No wonder, when Bevan needed agreements he wanted to keep quiet, he went to them instead. Of course, the BMA weren’t impressed, especially as it was the case that their members (often GPs, and in the days before the RCGP) were those that lost most due to the creation of the NHS – private practice was made more difficult and many of their members did go on to real hardship in the 1950s (Taylor’s book on general practice covers this well).
So strategy one is for the government to say – ‘of course you doctors voted against the creation of the NHS’, when things were are bit more complicated than this, and the Conservatives voted against the NHS bill repeatedly.
Strategy two for the government is to say ‘you are only protecting your own interests’. Ken Clarke made jokes about doctors reaching for their wallets every time he talked about change with them, and more recently, ridiculous attempts at smearing Clare Gerada have appeared for investing in practices in London (which successive governments have more or less directly encouraged GPs to do, and when Dr. Gerada would probably gain more than she’d lose from the NHS bill). The underlying claim here is that doctors are only looking after their own interests – they aren’t really interested in healthcare reorganisation.
The BMA voting for a ballot on pensions has given the government an open goal to aim it by claiming doctors are only looking after their own interests – in early coverage on the BBC website yesterday Lansley had already started down this road, calling for the richest to make their contribution to helping stabilise the deficit as well as the poorest. From this point on, every government representative facing a doctor has now been given another line of attack. The BMA have made a big tactical error going ahead with this ballot now – when the NHS bill was still going through Parliamentary discussion. The government have comprehensively struggled with the terms of debate on the NHS bill, but this moves things back in their favour.
The issues of the NHS bill and medical pensions are separate ones – one is about a completely silly reorganisation based on ideology, the other about how we pay doctors. There are issues about financing that span both, but the two issues will now be muddied but the government, and the doctors accused of self-interest. And some of that mud will stick.
Those of us who oppose the bill have just had their job made harder. I especially feel profound frustration especially on behalf of Clare Gerada, who has shown the doctors what real leadership is, and Clive Peedell, who selflessly ran six marathons in six days to bring attention to the injustices in the NHS bill.
It is now crucial, however, to redouble our efforts to make clear that opposition to the NHS bill is not about protecting provider interests – it’s about making sure there is an NHS to look after ourselves and our children in ten years. If we don’t stop this bill, this is under threat.
The BMA made a big error yesterday, but that doesn’t mean the NHS bill is any less wrong. Two wrongs don’t make a right.