Cameron defends moving NHS “from closed markets to open systems”

BMJ 2011; 342 doi: (Published 18 January 2011) Cite this as: BMJ 2011;342:d363
  1. Zosia Kmietowicz
  1. 1London

The prime minister, David Cameron, this week defended the government’s controversial reorganisation of the NHS, saying that his mission in restructuring public services was to bring “the promise of opportunity, fairness, and excellence for all.”

Speaking on 17 January at the Royal Society of Arts, two days ahead of the publication of the Health and Social Care Bill, which will put GPs in charge of 80% of the NHS budget, Mr Cameron said that the country “can’t afford not to modernise” and that the coalition government “has a once in a lifetime opportunity to transform our public services.”

Modernisation meant going further than any previous government had dared, he said, to eliminate entrenched inefficiencies and “opening up the system, being competitive, and cutting out waste and bureaucracy.”

Mr Cameron admitted that job losses in the public sector could not be avoided. However, he defended the need to push through the modernisation programme at a pace that many believe is too fast. “Every year we delay, every year without improving our schools, is another year of children let down, another year our health outcomes lag behind the rest of Europe, another year that trust and confidence in law and order erodes,” he said.

The reforms, which had been prepared during years in opposition, were a “complete change in the way our public services are run,” said Mr Cameron “from top-down bureaucracy to bottom-up innovation, from closed markets to open systems.” The reforms would see public service professionals being made answerable to people “rather than the government machine,” and he reiterated his ideas of the “Big Society,” in which local people help shape the services that make a difference to outcomes.

On the morning of his speech five unions, including the BMA, wrote a letter to the Times in which they accuse the government of failing to heed warnings that introducing competition on the basis of price will damage healthcare services (BMJ 2011;342:d331, doi:10.1136/bmj.d331). Plans for the NHS are “extremely risky and potentially disastrous,” the unions say.

Mr Cameron said that his plans for public service were ambitious but achievable. “We must champion excellence—and stop the slide against our competitors,” he said. While England’s spending per person on healthcare was similar to that in other countries, people here were more likely to die of cancer or heart disease.

He said that the NHS faced “enormous pressures” from an ageing population, rising levels of obesity and alcohol abuse, and demands for new and expensive drugs and the latest technology.

“Pretending that there is some easy option of sticking with the status quo and hoping that a little bit of extra money will smooth over the challenges is a complete fiction,” said Mr Cameron.

John Healey, Labour’s shadow health secretary, said that the Conservatives had a record of broken promises on the NHS and said that the coalition’s “high cost, high risk reorganisation” will put further pressure on the health service.

He added, “This isn’t just the wrong change at the wrong time: it’s a change the Conservatives promised they wouldn’t make. It’s no wonder David Cameron is on the defensive when all the experts are telling him to change course. He isn’t going to convince them to back his plans by calling the service they work in ‘second rate.’” Mr Healey was referring to an interview with the BBC Radio 4 Today programme in which Mr Cameron called the NHS “second rate,” although he later said he meant to say that the NHS should not be “second best.”

Mr Healey added, “David Cameron also seems to see the NHS as second rate when everybody else has seen big improvements by Labour in recent years and public satisfaction is now at an all time high. This is an insult to millions of NHS staff.”


Cite this as: BMJ 2011;342:d363


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