The state of the union


doctorThe BMA voted today to oppose the government's Health Bill. As with so much union opposition this is belligerent, based on confusion and misunderstanding. Let’s deal with a few of the main points:

1.The proposals were not in the manifesto.

This is touted around all over the news. It was raised on the Daily Politics today when they talked to the BMA. But on page 46 of the Conservative Manifesto 2010 it says,

We will strengthen the power of GPs as patients’ expert guides through the health system by:
• giving them the power to hold patients’ budgets and commission care on their behalf;
• linking their pay to the quality of their results; and,
• putting them in charge of commissioning local health services.

It doesn’t get much clearer than that. Dr Hamish Meldrum has said that they “didn’t see a lot of the detail until the Bill came out.” This is hardly cogent criticism. It amounts to saying that they didn’t see the Bill before the Bill was visible. They did see the manifesto (we assume) and they knew what it meant. Maybe they have just realized they might lose their monopoly.

2. The BMA agrees with commissioning.

Again on the Daily Politics it was said by the BMA that they agree with GP commissioning. What they oppose is the introduction of private companies into the NHS. Dr Hamish wants the NHS to be the preferred provider, with no competition. In other words he wants immunity for the NHS, despite the fact that costs consistently rise and value consistently falls. Spending has gone up dramatically, and things have got better. But there is an increasingly diminishing link between cost and value.

The Public Accounts Committee chairman Margaret Hodge has said: "The quality of the health service has improved as a result of this increase in spending. But the taxpayer has been getting less for each pound spent."

The idea that the NHS is an infallible good is nonsense. No party opposes subsidising health care for the poor, but that is not the same as opposing the unfettered growth of an inefficient public body: especially in light of the way we hear old people are treated, and the fact that our cancer survival rates are among the lowest in Europe.

This is not going to be a level playing field with private companies. Look at the manifesto again:

We will give every patient the power to choose any healthcare provider that meets NHS standards, within NHS prices. This includes independent, voluntary and community sector providers.

Could it be that the looming specter of choice makes the BMA uncomfortable?

3. There is a chorus of disapproval.

This is a classic way of trying to stifle debate with consensus, and thereby claim a victory. The idea that there is a majority opposition is wrong; it is typical of a body like the BMA to want to try and close off debate like this, and avoid the substantive issue. As Mill said, “All silencing of discussion is an assumption of infallibility. Its condemnation may be allowed to rest on this common argument, not the worse for being common.”

Supposedly, most GPs oppose the proposals. But 60% of them, who provide services to about two thirds of the population have already formed consortia. The BMA says this is because they are obliged to. But they are not obliged to yet, and if they really opposed it as the BMA says then they wouldn’t be taking the first opportunity they have to form consortia. The people making the noise opposing it are bodies like the BMA, whose position is threatened by these ideas. Perhaps if they provided more choice and better value for money they would have less to worry about…