In praise of the Liberal Democrat (party) and the BMA

As it stands, the White Paper for health and social care, ‘Equity and Excellence: Liberating the NHS‘ threatens the principles of universal social healthcare. Healthcare would be designed, bought and delivered by private companies, with huge competition for services that could be profitable, and no providers willing to take a financial loss to deliver required services. The health of patients and the public would be secondary to the profit motive, meaning less investment in non-invasive preventative measures and more focus on high tariff operations.

Perhaps worse is that to get these measures through will cost huge amounts of money in very difficult times, this was not in either parties manifesto and the Health Secretary keeps lying about there being evidence that health outcomes will improve when changes like this have not been attempted elsewhere in the world. It also appears he has been suppressing good news in the form of record patient satisfaction with the NHS, no mean feat given the hard time it feels it has been getting in the press.

I also want to briefly raise the question of localism to highlight my concern over strategic planning. I understand that some services are better planned and delivered on a local basis. My concern, however, is that increasing this localism will increase the element of ‘postcode lottery’ that is already in place. I can well envisage that different groups of GPs will want to invest in certain areas, and where there is variance in local need that is perfectly reasonable. However, without the national co-ordination given by Strategic Health Authorities or Primary Care Trusts or their local equivalents, the equity of services across and between areas cannot be expected to be the same. This means services will grow ever more different as there will be no centralising force, and so patients in Manchester will receive hugely different options to those in Liverpool. This is inequitable in terms of both service delivery, and health outcomes, dependent on nothing more than the area in which you live.

Perhaps the single greatest mistake made by the coalition government since not getting elected was removing the clinical value guidance role from the National Institute of Clinical Excellence. This body carried out detailed investigations into the clinical and financial value of treatments, giving doctors and other healthcare professionals clear guidance on appropriate drugs and interventions for a number of conditions. This allowed strategic planning of budgets, and also prevented the personalisation of drug value decisions. Giving this power to GPs to decide locally will remove any chance of proper strategic planning of treatments, and will require that patients ask their doctor to make funding decisions that will affect their wellbeing, rather than clinical or medical decisions.

I am not a Lib Dem. Since the election, I have not been a fan of the Lib Dems. This is not an attack on them, although if past performance can be used to predict future performance, I’ll have plenty of chance do that again in the future.

I am also not always a fan of doctors. They perform a vital and difficult role well, and we are blessed to have them.They tend to be medico-centric, and seem to fail to understand the complexities and importance of non-medical interventions, and the role early intervention plays in preventing problems. The view of any professional tends to stretch only as far as their duty or ability to act, and so doctors tend not to see beyond their doors.

This post is an attempt to highlight a good decision taken by the both the Liberal Democrat party and the doctors union, the British Medical Association. They have both recently decided to oppose the current proposed version of the Health and Social Care Bill. For this they deserve praise.

At the Liberal Democrat party conference the party voted in favour of two amendments to the Health Bill.

These amendments are meant allow NHS organisations to be designated as ‘provider of choice’. This means that the NHS provider body will be the first choice when a commissioner is looking to buy in or develop a healthcare service. This provides a protection for NHS providers against the ‘profitable’ services being cherry-picked by private companies competing solely on price, meaning that essential but unprofitable treatments can be cross subsidised by other services, and economies of scale realised.

There have also been steps suggested to ensure that the commissioning process, which involves the design and purchasing of services, is transparent and fair. There will be strict management of conflicts of interest, and commissioning will be carried out by a public body. This is intended to safeguard public money against the possibility of being spent on the vested interests of companies, rather than the healthcare needs of patients.

As suggested, I have concerns about this bill and am pleased to see these groups exerting some pressure. It is particularly warming to see the Liberal Democrats standing up to the Conservatives. However, even in this moment of triumph, I’ve got to ask whether it’s enough. It appears that the Conservative conviction may not be holding as strong as it was, but I would be very surprised if the plans were changed significantly, and much more so if they allayed my concerns.

I would argue that whatever the structure built up to support them, GPs are not best placed to design and purchase services. They are small private businesses, without the capability or expertise to deliver all of the containing services currently delivered by PCTs and SHAs. To develop this capability they would either need to employ the staff leaving the equivalent positions in the NHS, making the whole process an expensive redeployment of staff, or farm the management of the most important part of health service planning out to private organisations.

My time as an NHS employee is coming to an end, but I want the NHS to remain after I’m gone. The Conservative plans would destroy it. I am pleased the Liberal Democrats and BMA have decided to go against the plans, but I am very worried that this is not enough, and that once the damage has been done we’ll struggle to fix it. What I need to know is what can we do to prevent the worst. I’ll start with a suggestion – don’t vote for the Conservatives, perhaps unless you’re trying to stop UKIP or the BNP getting a seat, they try to destroy our social institutions every time you vote them in.

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