Modernising the health service

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Lord Collins of Highbury outlines his fears that the Health and Social Care Bill is driven by an ideology that sees the free market as the way to deliver healthcare efficiently.

'Trust me', the prime minister said when pledging 'No more top-down reorganisation of the NHS'. But for many who use and work in the NHS, that's precisely what they see when reading the government's plans for the NHS outlined in the Health and Social Care Bill.

Public confidence and trust will, I'm sure, be words that we will see written and hear spoken more than any others in the coming months in the debate over the government's Health and Social Care Bill. David Cameron knew in the general election just how vital his words were to win over a sceptical public who had confidence in the NHS but didn't trust the Tories with it.

For some NHS patients recently, that scepticism proved well founded. They received a letter from their GP practice offering minor surgical procedures privately as they were 'no longer paid for by the NHS'. One example given was an operation to remove an ingrowing toenail at a quoted cost of £146.95. For someone on a limited budget, in pain, with their mobility affected, such an offer would be neither minor nor cheap.

It was this that prompted me to put down a question this week in the House of Lords on 'whether general practitioner practices are permitted to advertise their own private healthcare services using the NHS logo'. It's a story that woke me up to the nightmare possibility of the doctor changing from a person who decides the best medical treatment for the patient to someone who tells the patient what can be afforded.

As Lord Hunt of Kings Heath said in the second reading debate on the bill, the doctor-patient relationship goes to the heart of general practice, but the government "....shows no signs of understanding the ethical tension between the role of GP as champion of the patient and the role of GP as rationer of services through commissioning".

My fear, and I think this is shared by many, is that it is ideology that drives the promoters of this bill. It's an ideology that sees a competitive free market as the way to deliver healthcare efficiently.

For me, modernisation of the health service must be about addressing:

- unacceptable variation in standards of care,
- inequalities and postcode lotteries,
- the lack of joined-up services across health, social, community and voluntary sectors, and
- the fixation with acute care rather than better primary care with more investment in prevention.

My real concern is that I do not see this bill as being helpful in addressing any of these key issues.

Ray Collinswas general secretary of the Labour party from 2008 until 2011. He currently serves as an Opposition Whip.