Beware... this bill will undermine a foundation of our welfare state

Published: 1 July, 2011

• THE coalition government’s introduction of the Health and Social Welfare Bill has caused consternation to many health professionals and to the public. Following its revisions, does the bill lead to better-planned modernisation of the NHS – or to its destruction?  

One strong objection is its proposal to introduce hugely expensive administrative changes now, at a time of harsh economic problems. Another is that it opens the door to an extension of privatisation, contrary to basic NHS principles.

On June 14, the health secretary announced a large number of changes to the bill. What remained obvious was that the extensive changes envisaged were already causing uncertainty and confusion about future NHS administration, leading many employees to fear losing their jobs, while many top medical professionals expressed opposition to parts or all of the bill.   

As the trade union Unison remarked: “It’s the wrong bill at the wrong time... It could  even require cuts to frontline services – and we are already seeing the closure of many hospitals and staff cuts.”

Many GPs are unhappy with the role of commissioning, which Andrew Lansley declared a key feature of his “reforms”. Adding that role to their basic task of providing individual patient care for which they were trained lands them with potentially conflicting responsibilities:  prescribing the best individual treatment or authorising the least costly.  

Passing over this task to “commissioning boards” (later renamed “clinical commissioning groups”) may really be an organisational name change, from the present strategic health authorities and local primary care trusts (whose staff are likely to transfer to them), rather than a reduction of one level of bureaucracy.

Promoting all hospitals to become foundation trusts – an aim to be achieved within a few years – allows them autonomy, under a “Monitor”, in managing  their own finances, such as signing contracts with whatever bodies they choose, and even selling off NHS assets.   

Competing rather than co-operating with other healthcare institutions, the more successful have no obligation to assist or contribute to subsidising poorer ones. Their localised autonomy would deprive a national Department of Health in full control of NHS financial resources of the means to attempt  fair distribution of health care provision nationally.

The NHS Future Forum, an independent group of 45 members launched in April, included leading professionals who were to “reflect on and improve the government’s proposals for modernising the NHS”. Its initial report on June 13 recommended sweeping changes to the bill, remarking that it was “riddled with flaws... and was beyond repair”. To this the government responded by explaining “significant changes to improve our plans in line with the forum’s recommendations”, promising that a parliamentary scrutiny of the bill by the House of Commons would follow.

Though often unfairly denigrated by the right-wing media, NHS  performance compares well with other western health organisations at admirably low cost.    Our NHS is a nationally-appreciated organisation, an essential foundation of a  humane welfare state. If we wish to prevent impending legislation from undermining our NHS by permitting its further  commercialisation we must follow future debates on this bill with critical care, and actively oppose its conclusions.

ANGELA SINCLAIR-LOUTIT
Highbury Hill, N5