This month the British Medical Association took the unusual step of launching a public campaign and, what is more, doing so in the lead up to a general election. While the BMA is, in essence, a trade union and therefore a political body, it tends to remain outside the political fray and claims no partisan political affiliation.
However, with all the talk of “weaponsing the NHS” and the fact that the NHS is a key election battleground, it appears the BMA has stepped in. Its #NoMoreGames campaign calls on all political parties to stop engaging in “Punch and Judy” exchanges with a particular focus on ending political game-playing in public health, NHS funding and who provides care to patients.
On the one hand it is a well-timed campaign. Many of the changes implemented by the Tory-led coalition government, particularly the 2012 Health and Social Care Act, have been seen as contradicting David Cameron’s pre-election promise not to engage in top-down reform. For example, the leading healthcare think tank, the King’s Fund, considers the reforms to be revolutionary and not evolutionary and is highly critical of the coalition’s record.
Whether or not the distinction between “any willing provider” to be considered for NHS work and its replacement with “any qualified provider” in the final 2012 Act holds any real significance is a particularly illuminating example of the political games being played. The apparent concession made by replacing “willing” with “qualified” will not, it appears, have any practical consequences, a point that both sides of the debate failed to make clear.
Another instructive example is the way that the promise to protect NHS funding from cuts can be called into question. Even if the budget is ring-fenced the NHS is still under significant financial strain, not least because the work required to implement the coalition’s reforms is itself unfunded. Jobs and services have been lost and the effort that healthcare professionals and managers have had to expend has been significant and has taken them away from their normal duties.
The Cancer Drugs Fund
David Cameron’s Cancer Drug Fund is a particularly apposite case of the nature, and logic, of game playing in healthcare. The fund was ostensibly formed to provide patients with access to expensive new cancer drugs on a largely case-by-case basis. However, it not only provides drugs that have yet to be evaluated by NICE, but those that have been rejected by NICE. So, in the first instance, it undermines a body that is vital to controlling NHS spending.
The supposedly noble aims of the CDF are also undermined by the notion that it was motivated by a political desire to prevent the damaging headlines that occur when patients cannot access treatments. However not only does this pre-emptive strategy have a high financial cost, it encourages Big Pharma to play games with negotiations over drug prices.
It is a short-term fix that is no longer viable. Last year the fund had a reported budget of around £230m, which it has overspent by around £60m. While the budget for the forthcoming financial year has been increased to £340m, 16 drugs that it previously offered have now been delisted. While some of these drugs have received NICE approval others will no longer be available. So if the aim was to avoid the headlines, they will likely return. And politicians of all colours – including Labour – are unlikely to risk considering eliminating the fund, regardless of the fact that it would be the right thing to do.
The stage is set
If politicians are guilty of playing games with the NHS then, at least in part, we must relate the problem to the court on which they inevitable play; the media. To blame politicians alone would allow the media – or sections of it – off the hook. They too should be understood as actors in political events. The conclusion is obvious: politicians are guilty of playing games with the NHS but the same charge can and should be levelled at some in the media who drive the game forward.
Labour leader Ed Miliband’s recent alleged comment that the party intended to weaponise the NHS is a great example of this. It could be argued that a health service weaponised by Labour may be in the best interests of the NHS – a point succinctly expressed by the cartoonist Chris Riddle following harsh criticism of Miliband’s comment and in an editorial by Polly Toynbee, in which she argued that with the introduction of Andrew Lansley’s ill-conceived legislation, the coalition government took an ideological step that diminished, outsourced and privatised the NHS and the welfare state more generally. In other words: “They primed the gun.”
Such actions mean that it is not only unavoidable but right that the NHS is seen as a key battleground in the forthcoming general election. However, after the media reported his alleged comment about weaponising the NHS, Miliband adopted a “no comment” stance and, as a result, seemed to accept the criticism. Given he lacks a defining mission it may have been better to embrace the idea, and to stand up for something nearly every UK voter believes in.
Having promised not to institute any top-down reorganisation of the NHS the government lacked the requisite mandate to make the reforms. Not only were they widely denounced at the time, they have had serious and negative consequences. The general election is the first opportunity the British public has had to express the opinion on the changes. The outcome of the election will also significantly determine the future of NHS; it is a referendum on furthering those changes or rowing them back.
In this context we must make a distinction between any short-term weaponisation of the NHS and any more general and widespread political game playing.
In the past five years, the government has offered the health service little in the way of positive change or, for that matter, political leadership during the recent “winter crisis”. In this context, the headline message of the BMA’s #NoMoreGames campaign should be seen as less of an intervention in the election than a foundation for policy-making following the result. Finally if, as Labour suggests, the NHS will not survive five more years of Tory rule, then winning the general election and saving the NHS are one and the same.
So if by “weaponisation” Labour means to make the NHS as toxic to the Conservatives as the Conservatives have made Labour’s record on the economy, then more power to them.