Diane addresses the British Medical Association

17 Feb 2011
Thank you to Kevin, and to the British Medical Association for inviting me to the Great Hall this evening to discuss the Government’s plans for the future of the NHS, with you.

I know how important the work of the British Medical Association is in giving a voice to doctors and medical students across the country.

My message to you, to Simon and to the rest of his Tory health team is simple:  at a time when every single penny is needed to maintain jobs and standards of patient care, it is nothing short of a disgrace to spend up to £3 billion on an unwanted political experiment with our NHS.

Top-down reorganisation is exactly what the Government promised to stop in their Coalition Agreement in May, and so they have no mandate for the break-up of a successful NHS.
 
A wave of protest – from patients, nurses and now even GPs - is rising across the country.

Patients aren’t asking for it.

GPs and NHS staff don’t want it.
 
The public did not vote for it.

It’s wrong for patients. It’s wrong for our NHS. It’s wrong for Britain. Simon knows this.



The Health Secretary is imposing his reorganisation of the NHS, whilst blocking out an onslaught of criticism from all sides: from patient groups, professional bodies and health experts. 

They have attacked the plans as high cost, high risk, a danger to the commissioning of key health services, and a costly distraction from the need to find efficiencies. 

Simon - you know you’re in trouble when even the Tory-led Health Select Committee is criticising the plans, saying they are unlikely to improve patient care. 3 out of 4 doctors don’t want the changes, and don’t believe they will improve patient care.

For GPs, the BMA’s own Hamish Meldrum, who has just spoken, has said “this change is going to replace one bureaucracy with another perhaps even more dangerous bureaucracy”.

For patients, the Patients Association warns about “instability” and “a serious impact on staff”.

For NHS managers, the NHS Confederation says “NHS leaders up and down the country are really worried about the prospects”.

And the NHS chief executive Sir David Nicholson told the health select committee he sees the Government’s plans in the same way: “The scale of change is enormous – beyond anything that anybody from the public or private sector has witnessed”.  

The idea that the Tories had clearly indicated their intentions to go ahead with this type of costly, top-down reorganisation is absolute nonsense, and Simon knows this.

By 2014, the Tory-led Government expects the NHS to have delivered £20bn efficiency savings without affecting the front line. They have made this impossible by introducing this huge, expensive reorganisation at the same time.




This evening, we need to focus on the Government’s Health and Social Care Bill and what it means. Simon wishes to hijack this discussion with partisan shots at the last Labour Government. 

But we need to have a proper discussion about this very real threat to the future of our NHS.  The threat is not theoretical but real. 

I am proud of Labour’s achievements on the NHS – the progress is your achievement: shorter waiting times, a million more operations, greatly improved infection control, far better survival rates for cancer and heart disease, none of them possible without the care and healing of our healthcare professionals. Voter satisfaction with the NHS rose from 55% to 71%, the highest Ipsos Mori has ever recorded.

The claims that this is simply the logical extension of Labour policies are inaccurate and diversion from the substance of the reorganisation. 

It is true that we encouraged many of the GP commissioning models that the Andrew Lansley is now pushing, but that process was always within a planned and managed system.

Labour used private providers when they could add something to the NHS and help it to raise its game, and when they could add capacity so that we could clear waiting lists.

The plans outline in the bill are something quite different – a fundamental ideological shift.

David Cameron told the House of Commons on 19 January:

“what we want is a level playing field for other organisations to come into the NHS”

Whereas, Simon Burns said the same on Newsnight that evening:

“It is going to be a genuine market. It is going to be genuine competition.”




So let’s turn to the bill and look at what it means for the NHS.  The bill is more than three times longer than the legislation that set up the NHS in 1948.

These changes will break up the NHS. These changes will open up all areas of the NHS to price-cutting competition from private health companies. These changes will take away from all parts of the NHS the requirements for proper openness, scrutiny and accountability to the public and to Parliament. They are driving free-market political ideology into the heart of the NHS and this is why doctors are now saying that, as it stands, the bill now spells the end of the NHS.




Andrew Lansley and Simon Burns are keen to focus attention on what seems most patient-friendly and easy to understand. Your GP will be in charge of an £80bn budget for your care. 

GPs are being told they will call the shots on deciding who provides care for their patients. 

But they’re likely to find their hands tied by Monitor, the Office of Fair Trading and the courts enforcing competition law. Their decisions challenged by private companies if they don’t accept any willing provider, especially if that any willing provider is willing to offer to undercut on price. 

GPs will find themselves required to make the decisions to change and cut services to hit the £20 billion challenge of efficiency savings.

But the much talked about move to give GPs control of NHS budgets is the tip of the iceberg of this legislation. The hidden bulk of the changes lie in opening up the NHS completely to the private sector and introducing competition on price. Almost every expert says competition on price is dangerous and risks patient care. Local hospitals will be destabilised as providers cherry-pick the most profitable patients by undercutting the NHS on price.

Simon wants to hide the great bulk of the ideological market and competition changes from public view, but tonight we must give these issues some proper scrutiny:
the introduction of competition on price

massively increased opportunities for the private sector through ‘any willing provider’

NHS resources – beds and staff – being used without limit to treat private patients as the cap on private patients for hospitals is lifted. This means private patients ‘jumping the queue’ while NHS patients wait for treatment.

services or whole hospitals being forced to close as the most profitable patients are cherry-picked by private providers

Only the most essential ‘designated’ services being protected if a hospital is forced to shut down. 

These ideological changes are too costly, too risky, too far, too fast.



The Tory-led Government has broken its promise not to conduct a top-down reorganisation of the NHS. That is exactly what the Government doing with this legislation.

It is an ideological commitment to competition on price and to a massively increased role for the private sector that is at the heart of the Tory proposals, despite their attempts to hide it.

For me, the incredible achievement of the NHS, is matter of what you believe in and what being in this job is all about.

David Cameron, Andrew Lansley and Simon Burns need to come clean with you about what really lies in store for our NHS. 



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