The combination of EU competition law and one small paragraph in the government’s health bill will open up the NHS to private competition…
There are certain patterns of behaviour that we have come to expect from British governments.
Firstly, tell the electorate you are planning to do something and then do the exact opposite. In the case of the health service, Cameron told the Royal College of Nursing (RCN) congress in April 2010 that he would “stop the top down reorganisations of the NHS”. Now the government is undertaking a fundamental attack on the NHS. To call it a reform would be a misnomer, vandalism would be a more appropriate description.
The second pattern: choose a fall guy. In the case of the tuition fees the opprobrium fell on Nick Clegg and the Lib Dems. In the case of the NHS, Cameron has chosen your trusted GP to be the fall guy. On the surface of things he will be transferring the £80 billion budget for health care to GPs. However, cunningly disguised in the same legislation are measures which will make it impossible for GPs to maintain those contracts within the NHS. Cameron hopes that we will blame them and not him for privatisation of the NHS.
The third pattern, and one we have already witnessed with tuition fees, is this: make sure key decisions are set in train before you bring your plans in front of parliament. In the case of health the government has already set up 52 “path-finder” GP consortiums. Supposedly these consortiums are “closer to the patient” but a survey by Pulse (a GP practice magazine) has found that 6 out of 10 are already in discussion with private companies to run the process. And that was before the Bill was put before parliament.
Even more fundamental to the attack is the use of EU competition law. This is how the attack works. Hidden away in the documentation accompanying the Health Bill is what in the history books will become the famous paragraph 5.43. Paragraph 5.43 says: “One new flexibility being introduced in 2011-12 is the opportunity for providers to offer services to commissioners at less than the published mandatory tariff price where both commissioner and provider agree.” There follows a laughable sentence which reads: “Commissioners will want to be sure that there is no detrimental impact on quality, choice or competition as a result of any such agreement.”
This one paragraph opens up the NHS to any private company who wants to undercut the NHS by offering temporary loss leaders just like the big supermarkets destroying your high street with their loss leaders. And this is where the EU comes in. For the first time the NHS will be subject to EU competition law. The government has taken a regulatory body originally set up under Labour, called Monitor, and has refashioned it and made its primary task “to promote competition”.
Here come the lawyers
This means that even if your local GP consortium wanted to keep its contract with the local hospital, it could be challenged in court by any private company claiming the right to outbid. Again, as with the big supermarkets, there will be no shortage of vulture private companies and lawyers ready to take a test case.
The writing on the wall could not be clearer. Every health trade union, every Royal College, including the Royal College of General Practitioners, the NHS Confederation which represents health service employers, and patient organisations, have said that this health bill spells the end of the NHS. For 62 years the NHS has provided a service which, relative to the money spent, has provided an excellent service.
The fourth pattern we have seen in the Cameron government is that when the opposition is evidence based and overwhelming they shout even louder “there is no alternative”.
But there is no shortage of alternative plans being suggested. Not surprisingly the main emphasis in the alternatives is along the lines of conserving the aspects of the system which work and improving those areas that NHS staff feel could be improved. The Government loves to say that NHS staff resist change but it’s obvious to anyone that NHS staff have changed dramatically in 62 years. For example just think how the “scoop and drop” ambulance staff of 60 years ago have evolved into the paramedics of today.
The chairman of the Royal College of GPs has told the government that all they need to do to improve quality is to change the composition of the Primary Care Trust boards rather than abolishing them. With reference to the Boards she stated on 17 January: “You would probably want a majority of clinicians (on the board), mostly GPs but other NHS staff too. It is not too late to change.”
On the tuition fees vote the government majority was very slim. Are we going to allow MPs to vote through the legislation which formally consents to the destruction of the NHS? Only people who are willingly blocking their ears can fail to understand the fundamental nature of this attack on the health service.