Senior doctors criticise NHS reforms

As a group of senior health experts send a letter to the House of Lords criticising the Government’s proposed NHS reforms and Andrew Lansley today defends his proposals at the Conservative Party Conference, the debate of the Coalitions health reforms is alive once again. Will the criticisms of the reforms make any difference to the passage of the bill, or is it now an inevitability?

Submitted by on Wednesday, 5 October 2011

Copyright Department of Health

It is often said that in politics, timing is everything. Clearly, this is something that the 400 doctors and senior health experts who signed a letter to peers who will soon debate the proposals, have taken to heart. Today, Andrew Lansley was hoping to be able to make a triumphant speech at the Conservative Party conference, hailing the revised NHS reforms as the way forward for the nation. He still will, but now he does so to an audience very aware that his proposed NHS reforms have, despite the ‘listening exercise’ imposed by Nick Clegg, become no less controversial.

The specific complaints that the health professionals make are not new ones; they say that the reforms will fragment the NHS, make it less effective and ‘do irreparable harm to the NHS, to individual patients, and to society as a whole’.  These claims will not hurt the government hugely; they have been the standard points made by opponents to the bill ever since it was proposed.

No one who currently supports the reforms will be dissuaded by this letter. This is not to say that the criticisms are irrelevant; they strike at the foundations of the reforms, lambasting the ‘commercialisation and marketisation’ of healthcare. Clearly however, the point of this letter is instead to keep the NHS debate in the minds of the public, and to put pressure on the government to change or scrap the reforms.

This is something that Ed Miliband has also been trying to do. At the Labour Conference last week, he once again claimed that ‘you can’t trust the Tories on the National Health Service’. Whilst this is a sentence which has been repeated so often as to become essentially meaningless, it is still one that could scupper David Cameron’s detoxification of the Conservative party, and one which could cause the Coalition significant problems if backbench Liberal Democrats become restless over the proposals.

Strangely, David Cameron’s reaction to this letter is to claim that ‘it actually praises the part of the Bill that’s about public health.’ Not only is this cherry-picking of the highest order, but it is not entirely true. Dr David McCoy, one of the signatories of the letter, has written in the Daily Telegraph that whilst many health professionals saw a ‘silver lining’ in public health, there are many threats.

He cites the organisational disruption of the reforms, the introduction of competition, the increased influence of business in the formulation of public health policy and the dissolution of primary care trusts each as individual threats to public health. This is hardly a ringing endorsement of the policy, and Dr McCoy is surely right to be sceptical; with McDonalds, PepsiCo and the Wine and Spirit Trade Association formulating policy, there is surely no hope of any responsible regulation on healthy living.

It is highly unlikely that there would be a rebellion amongst backbenchers large enough to defeat the government on this issue, but the delicate treatment of these proposals, and the personal identification of Andrew Lansley as architect of the bill (not since Prescott’s drive for devolution has a minister taken such ownership of a specific policy) show that NHS reforms will only be passed if they have reasonable public support. Although it would be difficult (and unwise) to abandon NHS reform entirely, by jettisoning Lansley in a reshuffle, Cameron could start from scratch without doing too much damage to himself or his party.

In a sense, all that the doctors who have signed this letter have achieved is to return the issue of NHS reforms to the table. The proposed reforms are essentially the same as they were before the ‘listening exercise’, as are the objections. It feels inevitable that these reforms will pass; though Cameron could stop them if necessary, that would involve the loss of a cabinet member and of a huge amount of political capital.

The government is too far down the road of reform to turn back now. At this stage, surely only the extent of the reforms and the way in which they are seen by the public are left to fight for. On the former, it is likely that as the plans have already been significantly diluted, any change will be minimal, though small changes could be made to appease critics.

The latter is much harder to judge, but it is difficult to see a way in which the Conservatives can salvage any credit from the situation. Even if the reforms are generally seen as a success (which is far from certain) the Liberal Democrats will take the credit as the moderating influence.

It is surely the case, that Cameron, like the doctors who so vehemently oppose this legislation, understands the importance of timing in politics. Implementing NHS reforms now (or at least before the Olympics) means that come the next election, people will be less angry, and the Conservative Party can run a campaign based on the economy and education, rather than purely having to defend their record on the NHS.