Dr Phil Hammond, GP and broadcaster

Oh, the perils of getting into bed with the Government. On 28 April 1997, 60 esteemed doctors signed a letter to the Daily Mirror, advising readers how to vote to save the NHS:

"As doctors, we see mounting evidence each day that the NHS is no longer able to care for the nation’s sick. Waiting lists grow, bureaucracy has snowballed, the sick lie on trolleys. Doctors and nurses are in despair. Accounting comes before care ...Your treatment depends not on your needs but upon where you live ...The internal market is a cancer eating away at your National Health Service. Left untreated it will destroy that service ... if the Tories get in again, the NHS as we know it will disappear. To protect its future we urge you to vote Labour."

Tony Blair was so chuffed with this endorsement that he sent Dr John Marks, GP and former chairman of the BMA, a thank-you letter and an invitation to sit with him at a press conference. Blair also came up with his risible election eve claim that "there are just 24 hours to save the NHS".

Nearly seven years later, he’s still trying to save it – and with policies the Tories wouldn’t have dared to introduce. In opposition, new Labour ridiculed PFI financing but were swiftly converted to it in office. Despite ex-Health Secretary Alan Milburn’s pledge that "the NHS is not for sale", all new hospital building projects are farmed out to private companies. This has resulted in lots of new hospitals, but most are too small, the risk transfer is inadequate and the mortgage interest repayments so high that lower profile areas of the NHS will suffer for years to come.

Even more contentious is that £2 billion worth of lucrative NHS elective surgery is to be offered to private treatment centres largely owned by overseas companies. According to New Labour philosophy, these private companies will not be competing with the NHS, they will be part of it.

By negotiating a single tariff for an operation wherever it is performed, the Government argues, the NHS will be driven by a market based not on cost, but on consumer choice alone. This seems unlikely. The cost of an operation may be fixed, but patients vary enormously in their fitness for surgery. Some hospitals or treatment centres may decide to cherry pick the easier cases and charge less than the tariff. And the NHS will always need to be a safety net to take on the difficult cases.

It is hard to see the distinction between the Tory vision of self-governing trusts and Labour’s foundation hospitals. As with the Tory internal market, the playing field is not level; hospitals in deprived areas with more complex caseloads will find it harder to hit the foundation target than those in more privileged areas.

Many of the doctors who endorsed New Labour seven years ago are having second thoughts, and half have come out publicly against foundation hospitals and private treatment centres. Dr Marks describes their creation as "gross hypocrisy"; his brother Vincent, a chemical pathologist, says it is "more detrimental to the future of the NHS than any other act since it was first created." But will it make their former buddy Blair pause for thought? Don’t hold your breath.

Guidelines in Practice, February 2004, Volume 7(2)
© 2004 MGP Ltd
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