NHS forum GP admits private patient doubts

GP who led government reform bill’s ‘listening exercise’ says changes could leave hospitals vulnerable to EU competition law The government is facing renewed pressure over its health bill after the GP who led its “listening exercise” admitted he should have done more to flag up concerns about private patients in NHS hospitals, and grassroots doctors meeting in Cardiff demanded further changes. Labour warned that the health secretary, Andrew Lansley, was still planning to create a “full-scale market” after Steve Field acknowledged that the government would leave hospitals vulnerable to European Union competition law due to the presence of private patients in NHS hospitals. Concerns about a backdoor privatisation of the NHS prompted David Cameron and Nick Clegg to appoint Field to lead the Future Forum review. As Field was addressing MPs, who are considering the bill again at committee stage, doctors in the British Medical Association defied their leadership to pass a motion at their annual conference criticising the “respray” of the health and social care bill. Field said a majority of NHS staff who attended his meetings had raised concerns about government plans to lift a cap on the number of private patients using NHS hospitals. Labour said lifting the cap, which was introduced in 2006, would help foster a free market approach in the NHS. Field said: “If you wanted a gut feeling from what was happening in the listening exercise – the feeling was actually the private cap should stay because people felt that would provide the protection. But it should be reviewed and put at a reasonable level.” He admitted he had second thoughts about failing to mention the cap in his report. “To be honest, we didn’t put as much in our report as perhaps we could have done. In fact, it was one area, when we reread the paper at the end, we might have been stronger on.” Field said he had decided not to address the cap because of mixed feedback from hospitals – at University Hospital Birmingham the cap is set at 1% while the Royal Marsden in London’s cap is set at about 30%. “So University Hospital Birmingham couldn’t bring money in which would actually help its NHS services,” Field said as he pointed out that lifting the cap would leave hospitals more vulnerable to competition law. “On the other hand, if you opened the cap it may be more likely to be under EU law and from competition and from Monitor. So when we weighed up the proposals and the problems that might arise we chose not to go into any great detail.” John Healey, Labour’s shadow health secretary, said: “Steve Field is right and this was a serious omission from the Future Forum report. Removing the private patients’ cap is a vital feature of the government’s plans to turn the health service into a full-scale market, which will see NHS patients waiting longer and open up hospitals to greater challenge under competition law.” Sue Slipman, the director of the Foundation Trust Network, said it was right to lift the cap. Slipman told MPs: “Depending upon the range of patient choices, it isn’t necessarily the case that there would be fewer NHS patients if you expand the facilities as a result of the money you can [raise]. It depends where you invest that money. “The term ‘private patient cap’ is a misnomer. This is all money that can be brought into the system as a result of any service which may derive from private patients. So, for example, if you run laundry in your hospital and any of that laundry is used by those who supply services to private patients, this counts against the cap. We believe that the lifting of the private patient cap would enable public providers to being more money into the NHS to benefit NHS patients.” The BMA membership rejected leader Dr Hamish Meldrum’s attempts to reassure them that key elements of the bill should not damage the NHS. Their motion said there was still anxiety about: • The role of the NHS regulator Monitor. They fear it will still promote competition between hospitals, even though Meldrum insisted that “competition has gone” as Monitor’s main duty as a result of changes following the NHS Future Forum. • Competition potentially being forced on the NHS through an extension of patients’ right to choose where they are treated. • The health secretary’s legal duty to provide a comprehensive health service in England. Dr Clive Peedell, a member of the BMA’s ruling council, said: “Grassroots doctors have seen through the smoke and mirrors of this government, which pretends that it has made major changes to the bill but hasn’t. Despite David Cameron’s claims that they have listened to our concerns and made significant changes, the main levers for the marketisation and privatisation of the NHS remain intact in the nill.” Dr Jacky Davis, a council member, said: “We are being sold a respray job, two write-offs welded together, and we need to look under the paintwork to see what’s there.” The overhauled bill would still allow “any qualified provider” – including private healthcare firms – to treat NHS patients, while competition would simply be rebranded as patient choice, she claimed. The vote is a setback for Meldrum, who also saw delegates vote to mandate the BMA to campaign for the withdrawal of the bill, which the BMA leader had warned would make negotiations with government difficult, especially after the union helped secure some key concessions. A Department of Health spokesman said: “This vote is disappointing because, only a few weeks ago, the doctors’ union said there was much in our response to the listening exercise that addressed their concerns, and that many of the principles outlined reflected changes they had called for. “The bill has changed substantially since the BMA first voted to oppose government policy. Our plans have been greatly strengthened in order to improve care for patients and safeguard the future of the NHS.” A separate call to scrap the bill altogether was defeated by 54% to 45% after Meldrum pleaded with members to “vote with your heads, not your hearts” and not take action that would leave the BMA marginalised and unable to influence the bill’s remaining parliamentary stages. NHS Health policy Health Public services policy Nicholas Watt Denis Campbell guardian.co.uk

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