When the facts are on your side, argue the facts

By Tom Keeley

It has taken some time, but it has finally become clear how the battle over the future of the NHS should be fought. In a considered and sustained critique, the BMA has shown that an opposition focused on arguing the facts can gain traction with the public and press. It should be a source of relief and embarrassment for the Labour Party that this organisation has done something that we have failed to do this year.

The Conservatives are now in an impossible position. The centrepiece of the reforms is giving power to the doctors, on the basis that they know what is best for health. The reasoning goes that doctors have an unrivalled knowledge of NHS in England. Now the same doctors are saying these reforms present a substantial threat to health care in this country. Lansley and co can’t have it both ways. Doctors are either the trusted guardians of the NHS, or they are not. The BMAs critique has three broad underlying themes.

Where is the evidence?
The BMA, and doctors acting independently, have challenged Lansley to produce evidence that these reforms will work. The problem here for the Conservatives is that there isn’t any. Past experience of GP commissioning has been patchy and mixed, showing GPs to be costly and unenthusiastic commissioners of health. Current worldwide experience of unrestricted private competition has shown it to decrease fairness in health provision.

Health care is different.
Part of the requirement of a market where any willing provider can compete, is that some providers be allowed to fail. Market mechanisms cannot operate unless this is the case. While in areas such as transport a failure is normally an inconvenience, failure in health care is a tragedy, resulting in death and loss. By any modern civilised standard this should be considered wrong. A system of health care, which allows hospitals to fail, is accepting death and loss as the cost of doing business.

Evolution not revolution.
The NHS needs to be constantly improved. Since its formation it has never been a perfect organisation and has always been in the need of development. However, past reforms have shown that the chance of success is higher if change occurs at a natural pace, with meaningful consultation as a prerequisite. It would be worth the Conservatives looking back at their own record on health and the introduction of the internal market. Many, if not most of the problems were a direct result of lack of consultation and ‘back of a napkin’ policy formation. Lansley’s current reforms have all the same hallmarks, but with a scope that is incomparable.

The lawyers adage goes “When the facts are on your side, argue the facts. When the law is on your side, argue the law. And when you don’t have either your side, pound the table”. For too long the Labour Party opposition on health has been one of pounding the table. An incoherent mix of ideological objection and doomsday prophesies of the death of the NHS. In the first critique to gain real traction it has been the facts that have been the most effective tool. The Labour Party would do well to take its lead from this example.

[This afternoon Labour will be proposing the following motion in the commons:

‘The government’s NHS reorganisation’
This House supports the founding principles of the National Health Service (NHS); therefore welcomes the improvements patients have seen in the NHS and supports steps further to ensure the NHS is genuinely centred on patients and carers, achieves quality and outcomes that are among the best in the world, refuses to tolerate unsafe care, involves clinicians in decision-making and enables healthcare providers to innovate, improves transparency and accountability, is more efficient and gives citizens greater say; recognises however that all of those policies and aspirations can be achieved without adopting the damaging and unjustified market-based reorganisation that is proposed, and already being implemented, by the Government; notes the strength of concerns being raised by independent experts, patient groups and professional bodies about the Government’s NHS reorganisation; further notes the similar concerns expressed by the Liberal Democrat party Spring Conference; and therefore urges the Government to halt the implementation of the reorganisation and pause the progress of the legislation in order to re-think their plans and honour the Prime Minister’s promise to protect the NHS.]