Here is my attempt to explain what is at stake in Parliamentary debates around the NHS bill. I think, for me, there are six points I’d like to raise against which I have seen no sensible government response.
1. There is no democratic mandate for a significant reform of the NHS. In the 2010 election, no political party proposed the present reforms, or anything like them. There was next to no debate on the NHS before the election. We were assured by David Cameron there would be no ‘top-down’ reform of the NHS.
As there is no democratic mandate for the NHS bill, it should be withdrawn.
2. At best, the evidence supporting increased competition in healthcare is deeply contested. The government have made a big play on research from Zack Cooper and his collaborators showing that ‘competition saves lives’. Now I think there are substantial problems with this work as I’ve written on this blog, on the LSE blog, in the Lancet, and in future publications. But even if you do believe this research, it doesn’t relate to the new NHS form – it relates to the NHS between 2006 and 2010. The same researchers have found little gain from public/private competition (between 2006 and 2010 it was primarily public/public competition).
There is next to no research showing the NHS bill is supported by research. It should therefore be withdrawn.
3. The government have made no clear case for their NHS reforms. In the last two years we’ve had a variety of claims about getting GPs involved in commissioning (they will struggle to take on this role, and end up outsourcing it to others), about reducing bureaucracy (but the reorganisation will probably increase the number of tiers of organisations rather than reducing it), about improving clinical quality (when many of the statistics they have shown are out of date or just plain wrong).
The government doesn’t seem to know what the their own NHS bill is for. As such, it should be withdrawn.
4. The NHS bill has been so amended it is now completely different, and should be scrapped and started again. The lack of clarity from the government as to what their NHS bill is about has meant that they have made over a thousand amendments to it. The NHS bill that went through the Commons has now been substantially amended. It is almost impossible to predict what the effects of such amended legislation will be. This bill is incoherent – what on earth are we doing allowing something to become law that has been found to be so faulty it has been amended out of recognition.
The NHS bill has been amended so often it is incoherent and its effects cannot be predicted. It should therefore be withdrawn.
5. The NHS bill is not supported by those who will need to implement it. There are now very few clinical bodies that even remotely support the NHS bill. Most actively oppose it. The government began this process claiming they had the support of clinicians. This is simply no longer the case. They have not listened to the concerns of doctors or nurses or other health workers.
To be a success, an NHS reorganisation requires the support of those who will implement it. This bill is not supported by the vast majority of health workers. It should therefore be withdrawn.
6. The NHS bill is not supported by the general public. Opinion polls suggest that the majority if people in England would like the NHS bill to be withdrawn. Despite the government’s repeated reassurances and amendments, it seems they have no faith in this bill.
The NHS bill not only lacks an electoral mandate, or support from the clinicians who will have to implement it, it is not supported by the public either. It should therefore be withdrawn.
To be clear, the NHS needs to get better. It is already doing pretty well in terms of equity and efficiency, but does need to improve its clinical outcomes. However, it almost impossible to see how the present reorganisation will make things better. The reorganisation is costing billions, and causing disruption to no clear end. We need to start this process again and ask what we want our NHS to look like in the future. We can then start to work out how to make the NHS better. This reorganisation, however, is a waste of time and money. The NHS bill should be withdrawn.