Doctors refuse to accept NHS reform bill

By Dr. Ananya Mandal, MDJun 29 2011

The NHS overhaul is still receiving criticism. The grassroots doctors meeting in Cardiff demanded further changes.

Labour warned that the health secretary, Andrew Lansley was still planning to create a “full-scale market” after Steve Field acknowledged that the government would leave hospitals vulnerable to European Union competition law due to the presence of private patients in NHS hospitals.

Field was addressing MPs, who are considering the bill again at committee stage, doctors in the British Medical Association defied their leadership to pass a motion at their annual conference criticizing the “respray” of the health and social care bill. Field said a majority of NHS staff who attended his meetings had raised concerns about government plans to lift a cap on the number of private patients using NHS hospitals. Labour said lifting the cap, which was introduced in 2006, would help foster a free market approach in the NHS.

Field said, “If you wanted a gut feeling from what was happening in the listening exercise – the feeling was actually the private cap should stay because people felt that would provide the protection. But it should be reviewed and put at a reasonable level.” He said he had second thoughts about failing to mention the cap in his report.

Field said he had decided not to address the cap because of mixed feedback from hospitals – at University Hospital Birmingham the cap is set at 1% while the Royal Marsden in London's cap is set at about 30%. “So University Hospital Birmingham couldn't bring money in which would actually help its NHS services,” he explained. “On the other hand, if you opened the cap it may be more likely to be under … EU law, and from competition and from Monitor. So when we weighed up the proposals and the problems that might arise we chose not to go into any great detail,” he said.

John Healey, Labour's shadow health secretary, said, “Steve Field is right and this was a serious omission from the Future Forum report. Removing the private patients' cap is a vital feature of the government's plans to turn the health service into a full-scale market, which will see NHS patients waiting longer and open up hospitals to greater challenge under competition law.”

Sue Slipman, the director of the Foundation Trust Network, said it was right to lift the cap. Slipman told MPs, “Depending upon the range of patient choices, it isn't necessarily the case that there would be fewer NHS patients if you expand the facilities as a result of the money you can [raise]. It depends where you invest that money. The term 'private patient cap' is a misnomer. This is all money that can be brought into the system as a result of any service which may derive from private patients. So, for example, if you run laundry in your hospital and any of that laundry is used by those who supply services to private patients, this counts against the cap. We believe that the lifting of the private patient cap would enable public providers to being more money into the NHS to benefit NHS patients.”

The BMA membership rejected leader Dr Hamish Meldrum's attempts to reassure them that key elements of the bill should not damage the NHS. Dr Jacky Davis, a council member, said, “We are being sold a respray job, two write-offs welded together, and we need to look under the paintwork to see what's there.” The overhauled bill would still allow “any qualified provider” – including private healthcare firms – to treat NHS patients, while competition would simply be rebranded as patient choice, she claimed.

Doctors at the British Medical Association’s annual representative meeting in Cardiff voted by 59 per cent to 35 for health secretary Andrew Lansley’s reforms to be withdrawn. A Department of Health spokesman said, “This vote is disappointing because, only a few weeks ago, the doctors' union said there was much in our response to the listening exercise that addressed their concerns, and that many of the principles outlined reflected changes they had called for. The bill has changed substantially since the BMA first voted to oppose government policy. Our plans have been greatly strengthened in order to improve care for patients and safeguard the future of the NHS.”