Intended for healthcare professionals

Editor's Choice

Through historians’ eyes

BMJ 2012; 344 doi: (Published 16 February 2012) Cite this as: BMJ 2012;344:e1112
  1. Jane Smith, deputy editor, BMJ
  1. jsmith{at}

Future historians of the NHS might look back on the early months of 2012 and wonder why so many health professionals and politicians suddenly started agitating against the NHS Health and Social Care Bill so late in the day (as the bill comes to the end of its passage through parliament). People have been criticising the bill since it was first published (BMJ 2011;342:d408, doi:10.1136/bmj.d408), but only now are organisations, and the Labour party opposition, calling for the bill to be withdrawn. A news story gives the list of those opposing the bill and also reports on a leaked risk assessment to ministers pointing out that a major risk of the bill is that the NHS could become unaffordable as private companies siphon off profits (doi:10.1136/bmj.e1062).

Our columnist Des Spence adds his voice to those seeking to ditch the bill, arguing that the current system is not broken and does not need mending (doi:10.1136/bmj.e1082). But it is Peter Bailey’s personal view—also urging abandonment of the bill—that provides an insight into this late surge of opposition: “I have to put my hand up and say that this mess is my fault” (doi:10.1136/bmj.e998). As vice chair of his emerging primary care consortium, he explains that some years ago his primary care trust was among the first in the country to recognise the financial challenges to the NHS and to do something about it. “Clinicians had to join with managers . . . primary care had to join with secondary care to agree on pathways that served patients better for lower cost.” And they were succeeding; being in the health minister’s constituency, they impressed him too, and they became pathfinders for the new commissioning groups. “Then we began to understand the proposed legislation. Primary care trusts were to be abolished and pathways were to become illegal, sacrificed to ‘any willing provider’ who would trample across them, waving competition on behalf of their shareholders.”

What that might mean emerges from Margaret McCartney’s Medicine and the Media piece on another bill progressing through parliament, the Welfare Reform Bill, and its provisions for assessing disabled people’s benefits (doi:10.1136/bmj.e1114). The Department of Work and Pensions, which administers these, has abandoned seeking medical assessments from claimants’ own doctors. Current assessments are done for the department by Atos, a French technology company. McCartney points out that disabled people have little faith in these assessments (BMJ 2011;342:d599, doi:10.1136/bmj.d599); they are computerised; and the basis on which they are done is not published. A senior occupational health academic who has independently reviewed the system of assessments has raised concerns about them and their ability to deal with complex chronic fluctuating conditions. McCartney is critical that medical organisations such as the BMA have not been making a fuss about this: “after all benefits for the most vulnerable people in society have been franchised out to an opaque system remote from the care in the NHS.”

Disabled people might well get better assessments from novelists than from Atos, if the BMJ’s glowing assessment of Charles Dickens is anything to go by: “What a gain it would have been to physic if one so keen to observe and so facile to describe had devoted his powers to the medical art.” This comes from a BMJ article on the death of Dickens in 1870, republished as a filler to mark the 200th anniversary of his birth (doi:10.1136/bmj.e630), which notes his detailed observations of people’s illnesses. The BMJ also commended him for being “always just, and generally generous, to our profession.”


Cite this as: BMJ 2012;344:e1112


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