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NHS: Under Threat

Despite the widespread concern and opposition to the coalition government's NHS reforms, the Health and Social Care Bill has received royal assent and is now an NHS act. I've got 30 years experience of working in the NHS, from a junior doctor to a GP, and then chair of a Primary Care Trust (PCT). In my fairly extensive experience you can make most things work - even across organisational, health and local authority boundaries - if you have the right working relationships which develop over time through honesty, openness and trust. The way this NHS act has been managed by the Department of Health and the government is a stunning example of how not to do things. Political parties know that the NHS is highly valued by most people in this country. Even the Conservatives at the last election pledged not to undermine it, and yet within weeks of taking office the coalition had implemented reforms that were in neither party's manifesto and are based purely on right-wing ideology. The Bill aims to take away the responsibility of the Secretary of State for Health over the NHS, creating more bureaucracy, introducing marketisation on a scale never previously witnessed, and turning GPs from clinicians into business managers. I am baffled as to why this Bill is being brought in now, at a time of supposed austerity. The NHS was created in 1948, at a time when the country was recovering from World War II. One of its key supporters, Aneurin Bevan, once asserted: "No society can legitimately call itself civilised if a sick person is denied medical aid because of a lack of means." I am not against reforms, but the ideology that a privatised health service can deliver the answers misses the whole point about why the NHS exists in the first place. In my view the fight over the NHS is comparable to Thatcher's poll tax, which led to mayhem across the country. The NHS is clearly under huge threat. It will be a completely different healthcare system in ten years time; a system which I believe will signal the end of the National Health Service, and a system that will be much worse in terms of access, equity, health outcomes and cost. At the heart of this NHS act is the complete privatisation of the NHS, a process that has deep roots in Thatcherite ideology. We may be witnessing the end of the NHS as a publicly provided, publicly-financed body. We are inexorably moving away from the traditional health service to one ruled by bogus choice, competition, market forces and diversity of suppliers. The NHS act allows newly formed clinical commissioning groups (the GPs body) to pick and choose patients and services. It is no longer mandatory to provide comprehensive care, and allows commissioning groups to introduce charges and private health insurance, as well as enter into joint ventures to outsource most work to private companies with vested interests, beyond the scope of full public scrutiny. The coalition believes that public money should be used to bring in more private providers and create competition. But using public money to help the private sector and introducing market forces into healthcare is anathema to everything the NHS stands for. This NHS reform is the biggest challenge to core NHS values. The coalition is planning to turn the NHS over to a plethora of private companies who either commission or provide services, or both. This is the wrong reform at the wrong time. There are many in the health services who share my views, and for all of these loyal NHS workers there is one single motive; to keep the NHS as a publicly funded service, for the good of the people, and not one that is only there for those with the means to access care or for those who can benefit financially from the ill of others. I really hope Labour repeals this hated act when they come to power. It makes me so angry that the Conservatives have got away with introducing it, aided by the unprincipled Lib Dems. Most worrying is the role of commercial competition, with Monitor acting as enforcer. By opening every NHS corner to "any qualified provider", the whole service can be taken over by likes of Virgin and Care UK, with a few token charities and mutuals. NHS hospitals, cherry-picked of lucrative work, risk bankruptcy when left with only complex cases. The NHS will just be a logo; a most cherished institution reduced from being the main provider of health services in England with one of the biggest workforces in the world, to a US-style insurance scheme, divorced from the actual delivery of care. It will become a bureaucratic governing body dishing out public money to private companies. The reforms will be demoralising, not just for professionals but for patients, who will begin to see fewer treatments available to fewer people as the NHS cuts start to bite, with wealthier people able to "top up" treatments. The rich really will be able to have much more. It's not just a postcode lottery - it's a tax code lottery. The NHS should be the central theme of the next election along with the economy. The Bill has now become law, but those like me who cherish the NHS will continue to fight for universal healthcare as a basic human right, regardless of whether they live in flourishing suburbs or inner city deprived areas. Kailash Chand has been a GP for the last 30 years and is former chair of the NHS Trust Tameside & Glossop. He was on the BMA council and general practitioner's committee until last year. He was awarded an OBE in 2010 for services to the NHS. He writes for the Guardian and other regional and national publications on health matters. )

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