Lansley has pulled off one of the profoundest reforms everBMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e2429 (Published 04 April 2012) Cite this as: BMJ 2012;344:e2429
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Nigel Hawkes is naive in comparing the HSCB with other threatened legislation such as the rise in tuition fees and the abolition of fox hunting. Unlike these examples the coalition government was never honest about its intentions for the NHS. The public were not told that the service was being opened up to the private sector; the p word (privatization) was never used except by opponents.
Instead the bill was dressed up in emollient spin about empowering doctors and other health workers (who later became 'vested interests') and giving patients more choice (without explaining where your choice lies if Virgin has won the contract to deliver NHS services in your area).
Far from opposition centering on ‘arcane issues’, the bill was in fact fought on all fronts by people with expertise in many areas including constitutional law and public health, but a lot of the concerns were highly complex and technical making it difficult to engage the public. The public were also let down by the media, many of whom didn’t bother to understand the more complex issues and constantly referred to the legislation as putting money and power in the hands of doctors. Little wonder the public didn’t rise up en masse when the media by and large failed to present the full picture or to invite opponents of the bill to explain their concerns.
He is also wrong about the BMA's reason for a move to opposition. The BMA saw, like all other major healthcare organisations and hundreds of thousands of their members, that the bill did none of the things that it promised and presented a huge threat to a succesful public service for no other reason than blind ideology.
Mr Hawkes opinion piece ignores the huge amount of work done by the bill’s many opponents, and is cavalier about the lack of democratic mandate (his list of Mr. Lansley’s tactics in getting the legislation through describes well the ‘shock and awe’ technique beloved of armies but hardly a recommended way of endearing yourself to the electorate in what passes for a democracy).
He finishes by commenting that ‘if the government had known then what it knows now, it would never have embarked’. The government should have had the courage to admit that the legislation was a disaster in the making, unwanted, unneeded and without any evidence base. I trust his cavalier attitude to what has happened is justified but predict he will be wrong about that as well.
Jacky Davis (Dr)
Competing interests: Founder member KONP Co Chair NHSCA
Nigel Hawkes contrasts the public demonstrations against the abolition of fox hunting and student tuition fees with the absence of such public engagement against the Health and Social Care Bill. In both something was being taken away from a privileged subgroup of the population who were able to mobilise support for their outrage. The Health and Social Care Bill is unlikely to take much from the privileged in society. Creeping privatisation will increase inequity in health care - at the same time as increasing costs - but the section of society who will pay the price is not in position to register their complaint. Perhaps the Royal Colleges should have been more active in their representation of the interests of those not able to represent themselves. It is worth noting that when health care reforms have been attempted in the USA the public demonstration of outrage has been marked - led by those in positions of privilege.
Competing interests: No competing interests