Royal College of GPs chair attacks NHS reforms

Clare Gerada tells the <em>New Statesman</em>: "This reform is so large you can see it from outer sp

In this week's magazine, Clare Gerada, physician and chairman of the Royal College of General Practitioners, talks to the New Statesman's Sophie Elmhirst about her fears for the future of the NHS, David Cameron's betrayal, and the ways in which patients will suffer as a result of Health Secretary Andrew Lansley's reforms:

We've got three big things going on at the same time - a massive reorganisation of the health service, alongside a serious financial situation, alongside the NHS having to make £20bn efficiency savings. So it is difficult to say which one is going to cause "X, Y, Z", but certainly patients are going to experience longer waiting lists; they'll see less choice available. Irrespective of whether the government says there is going to be more choice: there won't be more choice.

In line with the General Practitioners' Committee's stance against the reform bill's Quality Premium, Gerada is outspoken about performance-related bonuses for GPs:

In the [reform] bill, the government is suggesting that GPs be rewarded for keeping in budget. There is no problem in GPs having an incentive to practise good, evidence-based medicine. Where it becomes a step too far is where we are rewarded for keeping patients out of hospital. Because you have to trust me, you have to trust that I have stopped you from going to hospital because it is in your best interests, not because I am going to get £10, £15, £20 or whatever it is. And that begins to distort the doctor/patient relationship, which has to be fundamentally built upon trust -- otherwise what's the point of it?

Gerada speaks of being "absolutely surprised" by the reforms proposed by a coalition government she has had no discussions with:

Like others, I heard David Cameron say "no top-down reorganisation of the NHS". I was so relieved, because I had lived through 15 reorganisations . . . [But this reform] isn't so much putting GPs in charge of commissioning, but about dismantling the systems and the architecture of the NHS.

The NHS is our NHS. It is one of the last things that we as the people - the taxpayers - own, and by owning it our Health Secretary and our parliament is responsible for it. For £120 billion of taxpayers' money, somebody has to be accountable to parliament. . . . It is symbolic if [Health Secretary Andrew Lansley] is no longer accountable for our national health service.

Alice Gribbin is a Teaching-Writing Fellow at the Iowa Writers' Workshop. She was formerly the editorial assistant at the New Statesman.

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Forget the progressive alliance - it was the voters wot won it in Richmond

The Labour candidate on how voters have acted tactically for decades.

The Richmond Park by-election is both a triumph and a setback for the concept of an anti-Tory progressive alliance. As the Labour candidate, I was bombarded with emails and tweets saying I ought to stand down to prevent Zac Goldsmith being re-elected long after it was technically impossible for me to do so even if I had wanted to. I was harangued at a meeting organised by Compass, at which I found myself the lonely voice defending Labour's decision to put up a candidate.

I was slightly taken aback by the anger of some of those proposing the idea, but I did not stand for office expecting an easy ride. I told the meeting that while I liked the concept of a progressive alliance, I did not think that should mean standing down in favour of a completely unknown and inexperienced Lib Dem candidate, who had been selected without any reference to other parties. 

The Greens, relative newbies to the political scene, had less to lose than Labour, which still wants to be a national political party. Consequently, they told people to support the Lib Dems. This all passed off smoothly for a while, but when Caroline Lucas, the co-leader of the Greens came to Richmond to actively support the Lib Dems, it was more than some of her local party members could stomach. 

They wrote to the Guardian expressing support for my campaign, pointing out that I had a far better, long-established reputation as an environmentalist than the Lib Dem candidate. While clearly that ultimately did little to boost my vote, this episode highlighted one of the key problems about creating a progressive alliance. Keeping the various wings of the Labour party together, especially given the undisciplined approach of the leader who, as a backbencher, voted 428 times during the 13 years of Labour government in the 1990s and 2000s, is hard enough. Then consider trying to unite the left of the Greens with the right of the Lib Dems. That is not to include various others in this rainbow coalition such as nationalists and ultra-left groups. Herding cats seems easy by contrast.

In the end, however, the irony was that the people decided all by themselves. They left Labour in droves to vote out Goldsmith and express their opposition to Brexit. It was very noticeable in the last few days on the doorstep that the Lib Dems' relentless campaign was paying dividends. All credit to them for playing a good hand well. But it will not be easy for them to repeat this trick in other constituencies. 

The Lib Dems, therefore, did not need the progressive alliance. Labour supporters in Richmond have been voting tactically for decades. I lost count of the number of people who said to me that their instincts and values were to support Labour, but "around here it is a wasted vote". The most revealing statistic is that in the mayoral campaign, Sadiq Khan received 24 per cent of first preferences while Caroline Pidgeon, the Lib Dem candidate got just 7 per cent. If one discounts the fact that Khan was higher profile and had some personal support, this does still suggest that Labour’s real support in the area is around 20 per cent, enough to give the party second place in a good year and certainly to get some councillors elected.

There is also a complicating factor in the election process. I campaigned strongly on opposing Brexit and attacked Goldsmith over his support for welfare cuts, the bedroom tax and his outrageous mayoral campaign. By raising those issues, I helped undermine his support. If I had not stood for election, then perhaps a few voters may have kept on supporting him. One of my concerns about the idea of a progressive alliance is that it involves treating voters with disdain. The implication is that they are not clever enough to make up their mind or to understand the restrictions of the first past the post system. They are given less choice and less information, in a way that seems patronising, and smacks of the worst aspects of old-fashioned Fabianism.

Supporters of the progressive alliance will, therefore, have to overcome all these objections - in addition to practical ones such as negotiating the agreement of all the parties - before being able to implement the concept. 

Christian Wolmar is an award winning writer and broadcaster specialising in transport. He was shortlisted as a Labour mayoral candidate in the 2016 London election, and stood as Labour's candidate in the Richmond Park by-election in December 2016.