Save the NHS: The Battle Is Not Yet Won, But the Tories Are Under Severe Pressure

So much for promises. David Cameron and his government are notorious, to those who are awake and paying attention, for implementing policies that they never mentioned on the election trail two years ago, and for not having a mandate for their swingeing cuts to the British state that are disproportionately affecting students, the working poor, the unemployed and the disabled.

David Cameron has also been developing a reputation for broken promises. The most prominent, of course, was his promise that there would be “no more top-down reorganisation of the NHS,” followed by a complete volte-face, as he allowed Andrew Lansley to propose the most sweeping top-down reorganisation of the NHS in its entire 64-year history.

The breaking of this particular promise may come back to haunt Cameron, as the NHS is considerably more popular with the British public than any government, and the party that tries to destroy it, having promised not to do so, may well have signed its own death warrant by persisting with its privatisation plans in the face of widespread dissent. As the Guardian noted on February 20, in an analysis of the latest Guardian/ICM poll:

An outright majority of respondents, 52%, say that the bill — which would overhaul NHS management, increase competition and give family doctors more financial responsibility — should be dropped. That is against 33% who believe it is better to stick with the plans at this stage.

The 19-point overall margin in favour of abandoning the legislation is mirrored in strong leads for killing the bill across all social classes and regions, as well as among male and female voters.

Only the very youngest respondents aged 18 to 24, the least likely to vote, favour sticking with the plans, by 46% to 39%. Opposition hardens with age, and is at its most marked among the over-65s — who favour dropping the bill by a 56% to 29% margin. A third of Conservatives (31%) and a significant majority of Lib Dem voters (57%) also want the proposed law to be ditched.

Unwilling to lose face, rather than doing the honourable thing, and dropping a bill that is a wrecking ball for Britain’s most-loved institution, the Prime Minister is supporting his beleaguered health secretary, Andrew Lansley, even though a YouTube clip doing the rounds shows the hostility that Lansley engenders:

In desperation, however, it seems that David Cameron has broken another promise, because of the NHS, that will damage his credibility still further. In the Guardian today, Dr. Kailash Chand OBE, who launched an e-petition entitled, “Drop the Health Bill,” complains that, although his petition has secured nearly 167,000 signatures to date, it will not be debated in Parliament as David Cameron promised. As Dr. Chand notes, David Cameron said in 2011: “One of the points of the new e-petitions website is to make sure that if a certain level of signatures is reached, the matter will be debated in the house, whether we like it or not. That is an important way of empowering people.”

I imagine that this refusal to debate the bill will be strongly challenged, as was the attempt to sideline the debate on extradition that followed last year’s successful e-petition asking for justice for Babar Ahmad, the British citizen shamefully held for eight years without charge or trial in the UK pending extradition to the US. When the ensuing debate was shunted to Westminster Hall, there was such an uproar that there was a follow-up debate in Parliament, and the problems with extradition treaties — between the UK and the US, and throughout Europe — received their most thorough investigation for many years, with the potential that long-standing problems will finally be addressed.

In the meantime, Dr. Chand proceeded to demonstrate why it remains imperative that the bill be dropped:

This bill is about the privatisation of the NHS — profits versus patients. It will disenfranchise the most vulnerable people in our society, such as the elderly and the mentally ill, creating a two-tier system in which only the best-educated and wealthy citizens receive the top-class healthcare that should be available to all. The organisational changes that this bill proposes will cost the taxpayer £3bn. This is an appalling waste of money at a time this country can least afford it, and it is money that should be spent on bolstering frontline services.

Who supports these proposals? The BMA, the royal colleges, nurses, academics, public health professionals and the general public have all expressed concerns that have largely been ignored. The much vaunted “pause” was little more than a PR stunt to give the impression that the government was actually listening to the feedback received during its consultation. Yesterday, the NHS Tower Hamlets clinical commissioning group wrote to the prime minister asking him to withdraw the controversial health and social care bill. Even Tim Montgomerie, the editor of Conservative Home, called the bill a serious threat to the party’s long-term election prospects, and alleged that three cabinet ministers had more or less commanded him to say so.

And the chairs of CCGs (clinical commissioning groups), the torchbearers of Lansley’s reforms, are lining up to tell David Cameron that the bill is distracting them from working on clinical pathways, and distracting managers who are being forced to form commissioning support organisations, and urging him to drop the health bill.

The reality is that no one supports these proposals except Andrew Lansley and a handful of ministers who have staked their careers on these proposals and do not want to lose face.

He added:

Two things need to be done. First, keep signing the e-petition to put pressure on Cameron and let him know the public’s anger and disapproval. Second, delegates to the Lib Dem conference, and Lib Dem councillors standing in the forthcoming local elections, need to be heavily lobbied. Lib Dem activists, such as David Hall-Matthews, Lord Greaves, a Lib Dem peer, and many others fear the bill will be “political suicide” and as damaging for their party as its spectacular U-turn over university tuition fees. I hope Lib Dem activists will defy Nick Clegg over these dangerous, controversial, destabilising health reforms by seeking to “kill” them at a party policy-making spring conference next week.

The NHS reform bill is fundamentally flawed, complex, incoherent, dangerous, unsafe and not fit for purpose. A joint opposition by the medical royal colleges and the public can still force the coalition to drop the health bill even at this late stage.

Dr. Chand’s appeal — and this latest evidence of David Cameron’s fundamental untrustworthiness — follows yesterday’s similarly-worded attack by the British Medical Association, which has long opposed the bill. In a letter to 22,000 family doctors, Dr. Laurence Buckman, the chairman of the BMA’s GPs committee, denounced the bill as “complex, incoherent and not fit for purpose, and almost impossible to implement successfully, given widespread opposition across the NHS workforce.”

As the Guardian described it, Dr. Buckman’s letter also described the BMA’s fears  that “Profit-driven firms may oust GPs from their key role in deciding what treatments patients need because of creeping privatisation in primary care caused by the coalition’s NHS shakeup,” warning that “the relationship between family doctors and patients would suffer irreparable damage and that the reforms would be ‘irreversibly damaging to the NHS.'” The Guardian described it, accurately, as the BMA’s “most strongly worded criticism yet of Andrew Lansley’s radical reorganisation of the NHS in England.”

The Guardian also noted that the BMA’s views “reflect both the hardening opposition to the bill among medical organisations and, especially, the growing view among GPs that Lansley and David Cameron’s repeated promise that GPs will be the key decision-makers in healthcare as a result of the changes are a sham.”

As a result, there are hints about “GPs pulling out of clinical commissioning groups (CCGs) — the groups of doctors which will replace NHS primary care trusts from April 2013 — by urging them to take ‘an active stand’ to thwart reforms that, in the BMA’s view, would prove ruinous.” Dr. Buckman’s major criticism focuses on “the future role of the organisations which will provide commissioning support services (CSSs) to CCGs in the reformed NHS,” and he speaks for many when he recognises this as a front for privatisation that essentially involves tricking doctors into facilitating these changes — a situation that would make me enraged if I were a doctor being smooth-talked by the government’s snake oil selling privateers.

As Dr. Buckman explained, “These bodies will initially do some or all of the ‘back office’ functions, but we fear that, in time, they could become the de facto CCG management. CSSs will be required to be outside the NHS as ‘freestanding enterprises’ and in a market of commissioning support for CCGs as ‘customers’, by 2016 at the latest. We believe that this will lead to the privatisation of commissioning, destroy the public health dimension to commissioning, with a loss of local accountability to local populations, and is likely to exacerbate health inequalities.”

Dr. Buckman extended a lifeline to the government on behalf of the BMA, pledging to co-operate on new ways forward if Cameron axes the bill, but there is still no sign that the Prime Minister is prepared to give up.

Further concessions have been wrung out of the government, following a joint letter by Nick Clegg (finally scared into action by the ever-growing dissent in his own party) and the Lib Dem peer Shirley Williams, calling for further changes, including protections against the NHS becoming a “US-style market”. As the FT explained:

Mr Lansley signalled his willingness to accommodate such concerns when he told MPs on Tuesday: “We will be open to any further changes that will improve or clarify the bill.” In an apparent change of tone, Mr Lansley admitted such changes would be “significant”, something Number 10 had been unwilling to say just a day before.

This constitutes some sort of victory, but the only real triumph will be when the entire bill has been consigned to the scrapheap. Next week, the government will announce whatever concessions it intends to allow, but if the Tories fail to persuade their coalition partners, Nick Clegg will face rebellion at the party’s spring conference, when party members may well vote to drop the bill, making its demise official Lib Dem policy. Another spur to doing so came at the weekend, when 92.5 percent of the Royal College of Physicians also voted to scrap the bill, joining almost every other professional body involved in healthcare in opposing the government’s plans.

The RCP survey was organised by the “Lobby Your College” website, and as the RCP prepared for an extraordinary meeting, Dr. David Wrigley, one of the site’s co-ordinators, told the Observer, “The medical elite, close to the corridors of power in Westminster, need to take heed of grassroots doctors who have spoken out in huge numbers and said that they don’t want this bill foisted on the NHS. It would be another nail in the bill’s coffin if the RCP formally opposes it.”

As the Observer also noted, Sir Richard Thompson, the RCP’s president, was “under fire” from some of his colleagues for attending David Cameron’s exclusive Downing Street “summit” on the bill, a week last Monday, at which the Prime Minister “was heavily criticised for inviting only the small number of organisations that either back or have not rejected his restructuring of the NHS in England.” However, Sir Richard Thompson “used the event to stress the RCP’s concerns about the planned extension of competition in the NHS, and the potential for NHS patients to suffer as a result of the coalition’s plan to let hospitals raise 49% of their income in future from private patients” — a statistic that ought to leap out horrifically at anyone concerned with preserving the NHS as a largely impartial provider for all.

As the Observer also explained, “Dr. David Nicholl, a consultant neurologist at City Hospital Birmingham, who collected the necessary 20 signatures of RCP members to trigger the extraordinary general meeting, said that the medical profession needed to unite to stop the ‘dangerous’ bill.” He stated, “The bill is bad for the country’s health and healthcare and will increase inequalities. None of the hundreds of amendments the government has had to table so far deal with the fundamental flaws of the bill.” Warning that the bill would “increase the number of patients being treated privately by producing longer NHS waiting times,” he added, “So why the hell are the government forcing this through? Market theory is a disaster in health. People need to stop this bill; it’s plain dangerous.”

At the extraordinary general meeting on Monday, 80 percent of the 189 RCP fellows attending voted “to survey fellows and members for their views on the Health and Social Care Bill,” and 89 percent endorsed a non-binding vote that “the Health and Social Care Bill, if passed, will damage the NHS and the health of the public in England.”

Note: If you’re looking for a way of continuing to oppose this dreadful bill, then, as well as signing and publicising Dr. Chand’s e-petition, you can also support the campaigning group 38 Degrees’ billboard campaign. The campaign to pay for billboard adverts, designed to target Conservative voters in marginal seats ahead of the London mayoral election on May 3, has proven hugely successful. £120,000 was raised from supporters in just a few hours, and David Babbs, the director of 38 Degrees, told the Guardian on Tuesday that “the aim was to sway undecided voters to ramp up the pressure on the prime minister to ditch the bill.” The Guardian also noted that Babbs pointed out that the mayor “has a general duty to improve the health of all Londoners and a statutory duty to reduce inequalities in health outcomes across the capital.”

As Babbs said, specifically, “David Cameron has decided to go through with these reforms out of a political calculation that it would be more embarrassing to do a U-turn and would cause him political pain. We don’t think the NHS should be about political calculations, but if it is about political calculations, let’s change the calculations for him.”

In its latest announcement, 38 Degrees stated, “Amazing — more than 15,000 of us have chipped in already. Huge billboards will be going up in 150 locations across London on Monday morning. If another 5,000 of us donate by the weekend, we can take the ads to high streets across the UK! Can you join in?”

Andy Worthington is the author of The Guantánamo Files: The Stories of the 774 Detainees in America’s Illegal Prison (published by Pluto Press, distributed by Macmillan in the US, and available from Amazon — click on the following for the US and the UK) and of two other books: Stonehenge: Celebration and Subversion and The Battle of the Beanfield. To receive new articles in your inbox, please subscribe to my RSS feed (and I can also be found on Facebook, Twitter, Digg and YouTube). Also see my definitive Guantánamo prisoner list, updated in June 2011, “The Complete Guantánamo Files,” a 70-part, million-word series drawing on files released by WikiLeaks in April 2011, and details about the documentary film, “Outside the Law: Stories from Guantánamo” (co-directed by Polly Nash and Andy Worthington, and available on DVD here — or here for the US). Also see my definitive Guantánamo habeas list and the chronological list of all my articles, and please also consider joining the new “Close Guantánamo campaign,” and, if you appreciate my work, feel free to make a donation.