Unhealthy Bill

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Cameron's supposed retreat on the Health Bill and the resulting incandescent splutterings of Alan Milburn reveal splits within the ruling class and the vulnerability of the Con-Dem Government.

However, we must not be complacent. While the report of the NHS Future Forum has made some helpful recommendations it still falls way short of safeguarding the NHS from further encroachment by the private sector.

It is important that the Future Forum fundamentally rejects the Bill's abolition of the duty of the secretary of state to provide a comprehensive healthcare service in England. They state that there needs to be "absolute clarity that the secretary of state for health is ultimately accountable to Parliament for a comprehensive Health Service." Their recommendation that Foundation Trusts (FT) and Commissioning Boards be made publicly accountable is positive.

The most familiar element of the Bill is the plan to abolish Primary Care Trusts (PCTs) and hand commissioning (purchasing care) over to GPs. The involvement of clinicians in healthcare planning and the pledge to include nurses and hospital doctors is welcome, but this could have been achieved without the Bill.

Many GPs have rushed to set up commissioning consortia even before the Bill is law, despite the poisoned chalice of having to make an unprecedented £20 billion "efficiency savings". Very few are enthusiastic entrepreneurs. Most did so out of concern that they would be left behind. In the wake of this, PCTs across the country have been dismantled, causing chaos. Thousands of skilled employees have been lost to the NHS. Some have been snapped up by the private sector as they prepare themselves to take over failing commissioning consortia.

Cameron implied that the NHS would not be privatised and the NHS Future Forum is "very clear that the NHS should not be privatised". In reality privatisation creep has dogged the NHS for years. No government will ever try to sell it off en bloc because they know that the public would never let them get away with it - so they are privatising the NHS by stealth, parcelling it up and selling it off bit by bit.

Cameron pledged that Monitor, the regulator, would be charged with promoting integration of healthcare services as well as competition. The NHS Future Forum recommends that Monitor's primary duty is not to promote competition but to ensure the best care for patients. In the spirit of involving patients they recommend a new "Right to Challenge poor quality services and a lack of choice". Such citizen challenges imply competition, and could be a trojan horse to allow the private sector in.

The Future Forum recommends a "stronger push to offer personal health budgets". These would herald a tiered service, with a bottom layer of basic care which could be bought with the allowance, topped up by those who could afford it, creating an ideal market opportunity for health insurance companies. All hospitals are to become Foundation Trusts. FT status effectively means that hospitals will be run as independent businesses.

If the Bill is passed the cap that currently exists on the amount of private work that can be carried out in an FT hospital will be abolished. Imagine the scenario. A struggling FT hospital will prioritise private work to generate income, leaving NHS patients at the back of the queue. There will be no bailouts. A deficit will result in takeover by one of the many private healthcare providers who can't wait to get their hands on NHS cash.

Cameron was silent on the Bill's intention to open up NHS care to Any Qualified Provider. The NHS Future Forum acknowledges concerns that this will allow the private sector to get involved with large parts of the NHS, but defend the policy. They acknowledge that cherry-picking of the easiest cases by the private sector, leaving the NHS to deal with the more complex, costly patients, is a risk, but make no robust suggestions as to how this should be avoided.

The day after the Future Forum report Lansley said choice is essential. And choice means competition. Cameron insisted that the fundamentals of the original NHS reforms have been retained.The door to admit the private sector remains wide open.

The NHS logo will be kept as a kite mark, hoodwinking the public into thinking that the NHS they know and love is alive and well. Lansley's Bill cannot be safely amended. There must be no let-up in the fight to have it scrapped.