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BMA wrong to call for repeal of Health and Social Care Act

Hold up!

See that little date above?

This post was published years ago.

My opinions have changed over time: I think it's quite fun to keep old posts online so that you can see how that has happened. The downside is that there are posts on this site that express views that I now find offensive, or use language in ways I'd never dream of using it today.

I don't believe in airbrushing history, but I do believe that it's important to acknowledge the obvious: some of what I've written in the past has been crap. Some of it was offensive. Some of it was offensively bad. And there's may be some brass among the muck (you can make up your own mind on that).

Some of what I've presented as my own views has been me—wittingly or unwittingly—posturing without having considered all the facts. In a few years, I'll probably think the same about what I'm writing today, and I'm fine with that. Things change. People grow. Society moves forward.

The internet moves on too, which means there might be broken links or embedded content that fails to load. If you're unlucky, that might mean that this post makes no sense at all.

So please consider yourself duly warned: this post is an historical artefact. It's not an exposition of my current views nor a piece of 'content' than necessarily 'works'.

You may now read on... and in most cases, the post you're about to read is considerably shorter than this warning box, so brace for disappointment.

The BMA is asking members to sign a petition asking Government to repeal the Health and Social Care Act 2012. The leadership’s rationale is that the Act requires providers to compete, while the BMA believes that “collaboration and not competition is more likely to allow a greater integration of community and hospital services”.

I could not agree more: collaboration is more clearly in the interests of individual patients than competition, and collaboration seems at odds with competition. Yet I don’t think the BMA’s position should be to call solely for repeal of the Act: after all, the Act is not solely about competition. The legislation brought about many changes, some of which are working well.

For example, we are beginning to see the value of a new local authority perspective on influencing the wider determinants of health, as shown by the exemplary nominees for NICE’s local government public health award. This sort of progress can be found in many Local Authorities across England. To campaign for repeal of the Act is to surround this progress with a fog of uncertainty: repeal would reject this progress outright and move staff back into PCTs.

The Act limits the Secretary of State’s powers to intervene in the day-to-day running of the NHS. While the success of this has been questionable at best, we are beginning to see push-back against Government diktat. No one, except perhaps Lansley and Hunt, would argue that the NHS benefits from the Health Secretary holding operational control; yet repeal would reintroduce this.

The Act confers new responsibilities on NICE to support evidence-based social care. The Act provides the first (baby) steps towards regulation of healthcare support workers. The Act gives an unprecedented level of legislative support to research in the NHS. These may be small considerations in comparison to the problems of the Act, but outright repeal would (if I may mix metaphors) cast the baby and the bathwater both into uncertain territory.

How quickly the BMA seems to have forgotten the pain inflicted on our profession through restructure, job uncertainty, and redundancy. Excellent professionals left medicine — and especially public health — to pursue other careers, while others lived for years with the stress of the uncertainty of their positions. For the profession’s trade union to argue for yet another overnight reorganisation “so big, it can be seen from space” seems utterly perverse. Perhaps this is why, despite the BMA’s repeated urging, fewer than 4,000 people have signed the petition. Even if every signatory were a BMA member, this would represent less than 3% of the membership.

Repeal represents only a return to the past. It behoves professionals to put forward an alternative vision. For example, politicians refuse to discuss the threat to universal healthcare of having fewer taxpayers per patient as a result of an ageing population; yet the BMA is uniquely placed to devise a considered, collective, professional vision of the future of the NHS. To campaign only for repeal of what exists, and allow the next government propose and introduce yet another short-term model, seems to me to be a sure route to unhappiness.

The BMA should not call for repeal of the Act: this is opposition without a position. The BMA should identify the most insidious parts of the Act, and work tirelessly to scrap or rework them. But, more importantly, the BMA should thoughtfully advocate for the future health of the nation, not for a return to the systems of the past.



Versions of this post also appear on the BMA website and Medium. It's like it's hunting you down wherever you look, begging to be read.

I took the photo at the top of this post at BMA House in September 2012.

This post was filed under: Health, Miscellaneous, News and Comment, Politics, Tweeted, Writing Elsewhere, , , .

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