This week an unnamed Downing Street source called for Andrew Lansley to be “taken out and shot”. Now that seems rather harsh, the man can’t help being misguided and wrong. What he can do however is face up to his mistake and kill the Health and Social Care bill dead.
Pressure on the bill has been rising towards fever pitch in the last few weeks as it makes its passage through the House of Lords. The Royal College of Nurses, the British Medical Association and the Chartered Society of Physiotherapy all published editorials in their respective journals calling for the bill to be dropped. The chair of the Royal College of GPs Clare Gerada, has spoken out against the bill. Dr Charles Alessi and Dr Michael Dixon of the NHS Alliance and the National Association of Primary Care, who were previously pro-reform have withdrawn their support. A senior minister commented, with rather a flair for understatement “This is a politically rubbish place to be”.
With the smell of blood in the air and the public baying for more, MPs from every party are turning against the reforms. Lib-Dems are rebelling by asking that a risk report for North London NHS services, warning of failing hospitals and harm to health care be published in full for the whole country. There are also rumblings that a core of Lib-Dems will try and get their opposition to the bill on the table for their spring conference. The last time that happened caused the infamous “pause” in the bill, and as the Lords would be discussing the most controversial parts at the same time as the conference, a Lib-Dem debate could kill, or at least maul the bill beyond recognition.
The Conservative party is also fracturing under the strain. Three cabinet members have taken the unprecedented step of asking the influential Conservative Home website to publish an editorial against the bill to get Cameron to listen to reason. The Independent is reporting that at least one senior minister has told the PM to drop the bill. With such hostility being expressed towards it, if it is forced through then anything that does go wrong in its implementation gives opposition free reign to continue the “Tories can’t be trusted with the NHS” line ad infinitum.
Labour are feeling confident too, having in the last few weeks finally found a slice of firm footing against which to push back against the coalition. Surprising that it’s taken them this long to land any significant body blows. I’m sure anyone off the street could tell you that Conservatives are weak on the NHS and their attitude towards the rich, vis a vis the bonuses row.
This resulted in a rather heated PMQ’s where both party leaders claimed that the statistics for patient waiting times vindicated their position. James Ball at the Guardian posted an interesting dissection of two of the many claims. Where Cameron stated that waiting times were down since he took office, what he meant was median waiting times are down, from 8.4 weeks to 8.1 in 18 months. But if you take the mean average the reverse is true, when Labour handed over power waiting times were an average of 8.1 weeks but according to the latest figures from November it’s 8.4 weeks. This discrepancy gives some credence to the suggestion by Polly Toynbee that she’s talked to NHS staff who say they’ve had to fudge the figures by abandoning some patients to incredibly long waits to prioritise the majority getting fast service.
Considering these claims were made after Ed’s rather more devastating statistics that long waits, for over 18 weeks and over a year have risen 43% and 217% respectively. It was no surprise then seeing the joy on Ed Milliband’s face when Cameron began making the claims debunked above.
The future looks bleak for the bill. Already weighing in at over 300 pages, the number of amendments is now in the hundreds. The most significant being the one that the Lords voted on yesterday. Labour, having won significant cross-bench support, won on a majority of four to include a greater focus on mental health, in consideration for the fact that mental health accounts for 23% of the disease burden but only 11% of the budget.
Whatever overarching purpose the reforms were supposed to drive will surely be lost in the coming weeks. The only remaining argument for driving the changes through seems to be the fact that the coalition have been implementing them since they took office. To turn back now, so they say, will only cause more chaos in an institution simultaneously trying to enact an unprecedented 4% budget cut for four years in a row and gigantic top-down reorganisation. Of course dropping the bill also means a significant fracture within the government and makes them susceptible for another two years of shaming, at the very least.
As with most issues in politics, the public good seems to have gotten lost somewhere along the way. The reforms could have been a noble effort to empower doctors and nurses (not just GPs), the ones who know the most about the many real flaws of the NHS. Instead we got hundreds of pages of marketisation bile, wrapped up in a veil of “patient choice”.
The bill should be dropped. Go back to the drawing board and find out what what NHS staff actually need, rather than consulting them on a series of amendments. Given nearly two years of soul searching as to the future of the National Health Service I’m sure everyone working for it will have a sense of what could work and what simply won’t. Then we can get on with the job of improvement rather than ideological policy wonk.
Photo by University Hospitals Birmingham