Richard Horton: "With the government’s health and social care bill having passed through parliament, what now?
First, we must realise that although we may have lost the legislative battle, we have not lost the argument. When Labour’s Andy Burnham turned over the keys to the Department of Health before the 2010 election, the mandarins told him that if he came back there was only one issue to worry about – the money. What he could not do was devise another fantastically ambitious NHS reorganisation. The NHS had to be about quality and efficiency.
When Andrew Lansley’s bill was published, Burnham knew that proposals for the biggest upheaval in NHS structures since 1948 were not what the country could digest. The health select committee agreed. Running a £20 billion efficiency programme alongside a massive change in philosophy (a new era of private sector colonisation of health services) was simply reckless. Not one expert inside or outside government believes this is a sensible strategy.
We are about to see a phase of unprecedented chaos in our health services. Those of us who opposed the bill should not gloat as this confusion takes hold. People will die thanks to the government’s decision to focus on competition rather than quality in healthcare. The coming disaster puts even greater responsibility on us to overturn this destructive legislation and remove this undemocratic government.
Second, therefore, we must begin collecting rigorous and reliable information on what is happening to our health services. When the Conservatives introduced fundholding to the NHS in the 1990s, it took years before we learned that the promises ministers had made were false. There was no consistent improvement in services. There were no gains in efficiency. Patients did not benefit from giving greater autonomy to GPs over how they spent their budgets. But the news of this policy failure came too late to influence the political debate.
We can’t allow that delay to happen again. We need to ensure that health professionals who study the NHS – and there are many of them – turn their attention to the bill’s impact on the lives of those who will suffer the fragmentation and disintegration of services. We need to build the evidence base now to show how the government’s policy is hurting people.
Finally, we must convert our arguments and the evidence we accrue into effective opposition. Labour was slow to respond to the Cameron-Lansley assault on the NHS. Those of us outside politics need to work harder to provide the necessary tools to the only opposition we have left. That way I hope we can make the NHS the central issue in the next election. The health of this nation depends on it."
Richard Horton is editor of The Lancet.
Dr Jacky Davis: "It is inconceivable that we will all sit back and watch our NHS wantonly destroyed. We must make it clear to coalition politicians that we will not forgive their anti-democratic behaviour. There are more than a million people working in the NHS; our votes and those of our friends and families will be used to punish the politicians responsible for this, both locally and nationally. We must also hold Labour to its promise to reverse the legislation when it is back in power.
The fight must go on in other ways too. Many groups have woken up to the dangers of the health bill and joined with campaigning organisations against it. Public health doctors, medical students and patients have all organised to protest and these groups can work together in future. There must be some sort of public statement, possibly a high-profile conference, to decide the way ahead and it must be made clear to politicians that the fight is not over.
We must monitor the changes to the NHS once the legislation comes into effect. By its very nature it will be increasingly difficult to know what is going on, as the service fragments and financial dealings and patient outcomes are lost behind a convenient curtain of ‘commercial confidentiality’. It is essential that we keep track of the bill’s effects if we are to show we were correct in our predictions of its dangers. The coalition will certainly not be telling us about the problems that arise, their predilection to massage the truth being only too apparent in their introduction of the bill in the first place.
Finally, we need an urgent inquest into the abysmal failure of medical ‘leadership’. Early and united opposition would have seen off the bill long ago. Instead our leaders, in trade unions and professional bodies, saw ‘opportunities’ and decided they could work with it on our behalf. When they were finally persuaded to see the dangers, their policy changed to seeking ‘significant amendments’, despite the fact that the government showed no sign of conceding any.
Few organisations conducted a proper campaign, even after being mandated to do so. The leaders of the professions were only moved to opposition after internal struggles and grass-roots organisation. They have not represented their members. They must be held to account for their failure and the whole structure of representation needs critical examination.
In sum, we will need a combination of actions such as continuing media coverage, evidence about the detrimental effects of the bill, protests, occupations and perhaps a refusal to co-operate with the legislation – for example, a boycott of the private sector. This battle may be over but the war is just beginning."
Jacky Davis is a consultant radiologist and British Medical Association council member. She is writing in a personal capacity
Jonathon Tomlinson: "The first priority must be to protect patients, in particular those who are least able to articulate their needs or access care. The health bill is intended to convert healthcare and patients into commodities. GP will be pitted against GP and hospital against hospital, vying for patients. Patients will be expected to compare GPs and hospitals in league tables and shop around, competing with each other for increasingly limited resources. Hospitals will be allowed to succeed or fail according to the values of the market, irrespective of patient need.
Since it is far more efficient and profitable to care for people who are motivated and able to care for themselves, it is those patients who are lacking motivation and ability who will be the first to suffer. Services for people with mental illnesses, dementia, drug addiction and language barriers are being cut first because those who depend on them are least able to complain. We will need to take urgent action to protect them. ‘Occupy Healthcare’ as a movement will exist to show that healthcare for vulnerable people cannot be run according to the same business ethics as industrial healthcare. Day hospitals will need to be occupied. There is now a daily picket at the gates of Chase Farm Hospital to keep it open, with a view to occupation to prevent the closure of A&E and maternity.
The NHS has entered the political consciousness of the public more than at any time since it began. One urgent need is for all of us to get involved with the new democratic structures, however toothless they may seem. These range from patient participation in GP surgeries and GP commissioning groups, and membership of Health Watch and health and wellbeing boards to standing as non-executive directors at foundation trust hospitals and so on.
Finally, we have to reject industrial healthcare. It is unsustainable, unhealthy and immoral. It’s time to bring humanity and sustainability back to the NHS."
Jonathon Tomlinson is a GP in Hackney.
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