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Will Royal Colleges Sell Out The NHS?
The Health and Social Care Bill has split many of the professions involved with the Bill, none more so than the medical profession itself. Today the BBC has reported that in an attempt to demonstrate solidarity, three trade papers (the Health Service Journal, the Nursing Times and the British Medical Journal) will run a joint Editorial criticising the Bill - but crucially not calling for it to be withdrawn. This echoes events last week when several of the Royal Colleges backed away from open confrontation with the government by 'pressing for substantive changes' rather than calling for the proposals to be scrapped. More and more this is looking like a battle between different factions of the NHS workforce, with patients' views dropping off the front pages. So how much can the professions be trusted?
The proposals as they stand will put GPs in charge of most of the £100bn annual NHS budget. They will form the overall majority in all Clinical Commissioning Groups (the new funding bodies that will replace Primary Care Trusts) which will buy services from the practices they will continue to run (and in many cases own) while wearing other hats. Conflicts of interest like this were highlighted by the 'listening exercise' over the summer, and as a consequence the government introduced changes requiring CCGs to publish their constitutions. However, managing conflicts of interest will essentially still be left up to CCGs themselves. Leaving aside recent high-profile failures in self-regulation (the press, the banks), many of us also remember how in 2003 GPs took advantage of changes in the law to pay themselves an average of £17,000 a year extra whilst dumping responsibility for out-of-hours services that have in many cases all but disappeared.
Although hospital consultants will now have an advisory roles on CCGs, they will clearly be the junior partners. You can hardly blame them for complaining, but from patients' perspectives it's a sideshow. We're concerned about the fragmentation of the NHS, plans to run it for profit and the potential loss of a universal, comprehensive service that's free at the point of delivery. Which branch of the medical profession holds the upper hand if that happens is frankly irrelevant.
The press focus on the scrap between doctors is worrying for another reason - it could disappear overnight, taking away attention in the press and the Lords as it does so. We saw a very similar thing happen with the Mental Health Bill in 2007. After joining the Mental Health Alliance and campaigning vigorously against the Bill's proposals to curtial patients' rights, the Royal College of Nursing and other professional bodies changed their minds at the last minute. Why they did so will remain a matter of speculation, but it effectively sunk Alliance opposition. Some commentators (me for example) have noted that all the professions that withdrew their support were subsequently rewarded with greater legal powers, corresponding to higher status and of course higher pay. In other words, they got a slice of the pie.
I'd like to be wrong, but watch for a last minute deal that will let the Royal Colleges and the Government both claim victory whilst handing over the NHS to the private sector.