Residents of England would do well to heed, and act on, the warnings about the so called NHS “reforms” carried on last week’s front page. It is quite clear that the Government, without a mandate so to do, is intent on removing the foundations upon which the NHS is built.

Nye Bevan crafted the NHS based on a number of key principles that are as relevant today as they were at the end of the Second World War:

  • The need to have a nationwide system of state owned hospitals to ensure equal access geographically to the best medical skills available and to have an efficient means of direct (political) control of a key component of the care system
  • The need to ensure that the tax payer had a political route through which complaints about the scope and adequacy of the whole NHS could be voiced and from which answers would be forthcoming
  • The need to remove doctors from the process of spending money and setting priorities which patients might perceive as interfering with their care
  • The need to see the preventive, diagnostic, treatment and aftercare responses of the NHS as being guided by an overall intelligence having as its goal an increase in collective well being.

To place virtually the entire financial resource of the NHS at the disposal of a fragmented array of largely self employed, small scale, medically qualified businessmen threatens each of these principles.

For as soon as a fragmented GP service begins to shape the range and capacity of hospital care in response to immediate and localised patient needs  – with the needs of the private provider in mind – the first and fourth  principles go.  As for the second principle, what redress through the political process does the patient have for a wayward, lazy or ill informed referrer? For what can Mr Lansley to be held to account? Clearly the third principle is also threatened as GPs will increasingly have to make decisions on priorities that, rightly, are based on politics and not medical science. (For example, I am not aware of any medical knowledge that equips GPs to determine what factors should determine the scope of (free) access to assisted conception services when compared with the scope of access to those services offering terminations of pregnancy).

This is not to demean what GPs do; it is simply to recognise that, since 1948 they have chosen, as self-employed contractors, to stand aside from the NHS believing that this independence offers safeguards to themselves and their patients. It is also to recognise, as those of us who have worked in the NHS know, that “contracts” and market mechanisms are inadequate tools by which to steer and shape this fine but complex care system.

At this time those of us in Scotland and Wales where the NHS remains untouched can only shake our heads in disbelief, count our blessings, and wonder whether the people living in England deserve to lose their NHS in this way.

Professor Tony Beddow 2010

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