Observations Health and Social Care Bill

Why legislation is necessary for my health reforms

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e789 (Published 01 February 2012) Cite this as: BMJ 2012;344:e789

Re: Why legislation is necessary for my health reforms

Dear Mr Lansley,

I have read your article ‘why legislation is necessary to my health reforms’. You make four points. The first three are non-contentious and the fourth starts off offering power and responsibility to the public and NHS staff with which no one would argue. This sounds good but then at the end of the last point you slip in the sentence ‘for doctors and nurses it means giving them the overall responsibility in each local area for the NHS budget.’ This is precisely the part of the Health and Social Care Bill that is totally unacceptable to me. It is not right to give doctors a finite budget (which could easily be reduced or clawed back in future years) and expect us to provide medical services to a population increasing in numbers and expectations and with increasing medical costs. Delegation of fiscal responsibility may be a management strategy which works in business, but the NHS is not a business but a caring organisation.

Let me remind you of the two models of health care which though very different from each other have integrity from the medical point of view.

The first is a national health service which is centrally funded and free for all. We are familiar with this in the United Kingdom. If the country cannot afford to pay for this any longer it is up to the politicians, doctors and the public to decide how to ration medical care in a fair way. I am glad to see that Dr Vautrey (Deputy Chair of GPC) has spoken about this recently (Debating the NHS reforms - Pulse 6.2.12). It is a shame that politicians have not had the courage to do the same. I believe it is your responsibility to lead on this and I am sure the medical profession would support you and engage constructively with you in this discussion.

The second way a health service can be run is a private system. We are not used to this in our country but it is a legitimate system in which doctors can work and the outcome of a true market economy. You pay for health care. If you can afford it you obtain the best and of course there will be many who suffer with poor or no health care. Here lies a large role for charitable institutions and hospitals. This will be unpalatable to many in this country but is a fact of life in most of the world as my 3 years as a medical officer in Sierra Leone in the 1980s reminded me.

What is not acceptable is your ‘middle road’ where the public are offered free health care with massive expectations and yet the responsibility for delivering this is given to doctors with a finite budget over which they have no control. In a true market economy the providers (doctors) would have the power to raise their fees to take into account rising costs.

Please don’t forget that the budget for health care is not ‘your’ money. It belongs to the taxpayers, you are only steward of it. It is not right to try and absolve yourself from being responsible for the Health Budget. That is exactly what you are responsible for.

However I would fully support you, if you started a discussion with doctors, other health professionals, and the public about what can be afforded on the NHS and what cannot.

I am retiring from full time general practice in a few weeks time having started 35 years ago. I wish you well and hope in the future your name isn’t linked with the NHS in the way Dr Beeching’s name is linked with the railways.

Dr Michael Price MA MRCP MRCGP

Competing interests: No competing interests

09 February 2012
Michael E Price
General Practitioner
Reepham Surgery
Reepham, Norfolk