NHS bill pause just a ‘political device’, medical chief says

By Alex Stevenson

The government’s promise to pause its bill on NHS reforms for a listening exercise is a mere “political device”, a medical boss has said.

Speaking to politics.co.uk, Hamish Meldrum, chairman of council at the the British Medical Association (BMA), said David Cameron should withdraw the health and social care bill completely rather than amend the legislation.

“At the risk of using a very abused phrase, I agree with Nick [Clegg] that ‘no bill is better than a bad bill’,” he said. His comments underline the difficulties faced by ministers as they seek to identify areas of compromise.

Interview: BMA’s Hamish Meldrum

Extensive negotiations with health secretary Andrew Lansley and senior government officials have seen the BMA united with other health organisations in opposing the bulk of the legislation.

Among the most significant aspects of the bill opposed by the BMA is the plan to hand healthcare regulator Monitor a statutory obligation to promote competition exclusively.

“Most people would believe the prime function of any organisation in the NHS is to ensure the provision of high quality comprehensive health services,” Dr Meldrum said.

“At best competition is one of many means to that end.”

Experts say it pervades the legislation, however, prompting Liberal Democrat backbencher John Pugh to describe it as a “Jekyll and Hyde” bill.

The BMA believes encouraging competition will have a negative impact on long-term care, which requires cooperation and coordination between different aspects of the health service.

Dr Meldrum said he feared fragmentation could take place if the most profitable parts of the NHS are “hived off” to private companies, leading to fragmentation which could in turn damage education and training.

He argued there was an insufficient evidence base for proving introducing competition would improve health outcomes.

“If you want to see what competition can do to a healthcare system, just look at the United States,” Dr Meldrum added.

“You see not only the high costs but also the wide range of outcomes and quality and still a fifth of the population getting a level of healthcare that we would find unacceptable.”

Concerns about the timing of the reforms, which are to be implemented as health professional struggle to identify £20 billion of efficiency savings, have only served to deepen opposition from within the NHS.

The BMA is concerned that patient safety and quality are not undermined as a result of the “artificially rigid timetable” to implement the proposed reforms.

Under the government’s plans all NHS trusts will have to adopt foundation status by April 2014.

Dr Meldrum said he was happy to participate in the listening exercise, although the concerns had been raised for nine months beforehand.

He reiterated his view that there were no concessions which would make the bill acceptable in its present form, however.

“If you change the bill to the extent we’d like to see it changed, is it the original bill changed or is it a new bill?” he asked.

“I personally think it’s nearer a new bill, but I’m not really that bothered if they want to call it changes. What I’m bothered about is seeing changes that meet the criteria we’ve set down.”

politics.co.uk understands Liberal Democrats opposed to the bill as it currently stands are expecting a response from ministers within the next few days.

Meanwhile Mr Lansley will speak at the NHS Leadership Council later today, before taking part in the latest government listening event.