Get rid of the market in health care, says Dr Hamish Meldrum

A call to get rid of the damaging market in healthcare once and for all came today from BMA Chairman Dr Hamish Meldrum in his keynote speech opening the British Medical Association's annual conference held this year in Edinburgh.

Speaking to more than 400 UK doctors, Dr Meldrum said: "We've had the market in England for nearly 20 years. Where's the evidence that it works?

Dr Meldrum continued: "Where's the balance sheet that shows that the argued-for and promised increase in efficiencies and decrease in costs outweigh the transaction costs and bureaucracy of the market? Show me the evidence that for most of what we do - emergency care, long-term conditions and primary care - the market improves rather than detracts.

"Instead we get competition not collaboration; fragmentation not continuity; inefficiency not efficiency. Not good for doctors, not good for patients, not good for the NHS."

Devolution had always been portrayed as the three Celtic nations breaking away from England. He said: "In the case of the NHS it's been the other way round; England has broken away from the rest of the UK" He urged doctors to look at the Scottish model which operates without a competitive market among healthcare providers.

"The BMA wants to see an NHS untarnished by a market economy, true to its beginnings, giving the public a fair, caring, equitable and cost-effective health service. Not a service run like a shoddy supermarket war. If it can be done here in Edinburgh, it can be done in England.

"Let's stop pretending that healing the sick is like trading a commodity. Let's stop diverting doctors' energies into unholy bidding wars for jobs they already do. Let's follow the Celtic lead and get rid of the market in healthcare once and for all. What a pity Ara Darzi missed his golden opportunity to do that."

"I'm not saying that everything's perfect north of the border, but at least there seems to be a shared agenda, a willingness and an eagerness to pull together that you don't see south of Hadrian's wall or east of Offa's dyke."

Dr Meldrum said that the BMA had come up with a credible alternative to the English system with much greater patient, public and professional decision making, freed from day-to-day political interference, at both a national and local level. Allied to this would be a system of collaborative commissioning, with doctors from primary and secondary care working together, with patients, to determine the best way to ensure that the best use is made of the finite resources of the NHS.

"Politicians in England, including Lord Darzi, may talk about this, but nothing in their policies will deliver it whilst they remain obsessed with the market and with commercialisation of the NHS" said Dr Meldrum.

Earlier in his speech the BMA Chairman said everyone must learn from the shambles and disaster that characterised last year's training post arrangements for junior doctors. In all aspects of the NHS, policy makers must listen to those who really represent the profession, he said.

He warned that the UK still lagged behind most developed countries in terms of overall doctor numbers, despite the welcome increases over the past few years. Attempts to blur the role of doctors or erode their professionalism, led to poor morale.

"We have had enough, the profession has had enough - worst of all - the NHS has had enough of those who ignore the views of those who are best placed to know what will work and what will not. We're fed up with politicians only listening to those who tell them what they want to hear rather than what they need to hear. And simply appointing a friendly, tertiary surgeon as a minister isn't the answer".

There was much doctors could support in principle in the latest plans for the NHS in England, said Dr Meldrum, but fine words and aspirations had to be matched by realistic, sensible implementation. And the auguries for this were not good.

Highlighting the BMA's position on polyclinics, Dr Meldrum said doctors had collected signatures of 1.25 million patients supporting the current model of general practice and against commercial companies providing general practice. He said:

"The message to the government couldn't be clearer, listen to the doctors, listen to the BMA, above all, listen to the patients of England."