Most health care professionals vociferously opposed Britain’s new Health and Social Care Act in the final few months as the House of Lords debated its fate.
Opposition was especially strong from family doctors (GPs), who, on the face of it, should have seen themselves as beneficiaries of new powers and control, but most of whom have seen the proposals as a threat to them and to the National Health Service.
Although they have remained technically independent contractors and thus ‘private’ providers themselves, since the NHS was established in 1948 GPs have been almost exclusively reliant upon their contracts with the NHS for their regular income. The private sector market for primary care is almost non-existent and mostly confined to the super-rich who can afford to pay privately.
Private health care in the UK is extremely small compared with the £100 billion a year public sector provision consisting mainly of a network of small-scale and limited-service private hospitals averaging 50 beds. They also delivering almost exclusively low-risk elective treatment, but in recent years have become increasingly reliant on income and patients referred and funded through the NHS. Private health insurance covers no more than one in eight people, mainly through workplace-based schemes.
Repeated surveys of GPs showed a growing majority against the bill, with the final poll by the Royal College of General Practitioners registering 98 percent against the bill, and a majority calling for it to be dropped. The British Medical Association, which represents hospital doctors as well as GPs, took an increasingly tough line, eventually calling for the bill to be withdrawn, and then it joined other health labour unions in a large protest rally against the bill in early March 2012.
The main opposition party, the Labour Party, also toughened its line during the long process of debate, to adopt last autumn a position of opposing the bill as a whole, and promising to repeal or reverse it when they are next in office.
This issue was then made a central focus of Labour’s campaign in the local government elections in early May, which saw widespread electoral gains for Labour at the expense of the coalition parties which both suffered heavy losses: Labour is now some five points ahead in the polls, and the credibility of Prime Minister David Cameron, who personally intervened to ensure the bill would pass, has dropped to a historic low at least partly because of this unpopular policy.
The battles over the bill, and widespread frustration among health professionals at the passive line adopted by Labour until the final stages of the campaign have led to the formation of a National Health Action party of doctors, which is preparing to stand against Liberal Democrats in targeted seats in the next election.
Ministers clearly still feel vulnerable on the bill and its consequences: Health Secretary Andrew Lansley has invoked a veto to over-ride repeated rulings under the Freedom of Information Act requiring him to publish a “risk register” outlining the potential problems in implementing the bill, which was withheld from MPs and the House of Lords throughout the debate.
As a new wave of cost-cutting measures, mergers and closures of local hospital services – delayed until the bill was safely in place – now takes shape in England. Liberal Democrat and Tory ministers have been seen joining local protests and campaigns against hospital cutbacks and closures in their constituencies now being implemented by their own colleagues.
The combination of a looming cash squeeze and controversial restructuring means that the Bill and its consequences are likely to offer headline and feature material for health journalists for many years to come.