The hype surrounding the dismal budget has rather obscured what had been billed as the big news of the year – the Tory healthcare plans are now ready to be signed into law. The promise of no more top-down reorganisation having been cast aside (indeed, Andrew Lansley has been preparing for this for years, he tells us), we have a significant, and significantly amended, health and social care act about to change the NHS landscape for years to come.

For all the bluster thrown at us by its supporters, the bill will simply not deliver on its core promise of improving the patient-centred nature of our health service. Clinician-led commissioning is a great idea, provided that means all those included in the care of patients, not just private contractor GPs; and it all begins to look a bit more sinister when those same GPs will be paid more to use fewer services. It took the BMA and others a day to work out what Lansley missed in his years of planning, and what we are left with is a bill longer than that to establish the NHS in the first place, with far too many flaws, and massive opposition from the very clinicians and patients it is meant to help.

The other mainstay of the bill is, of course, choice – choice which is of course an illusion, with money being whipped away from the service, and, as we have seen this weekend, with no reinvestment when financial targets are exceeded. Instead, this is a bill that will increase localism, beyond that which we already have with our deeply unfair postcode lotteries, and with budget cuts will simply push an already overstretched service to the brink of fiasco. There is choice – but only for the private companies, as to which services they think will make them the most money.

Some proponents of the bill have said that all it does is continue the New Labour ideas of including the private sector in provision of healthcare. This is patently not true – what the bill does is begin to marketise healthcare in a way not seen before. Private healthcare companies will be able to push for the most profitable contracts and this will lead to a worsening in the financial viability of our NHS providers, who will be forced to take on the more difficult and expensive procedures. Which for-profit company in their right mind would take on A&E, a specialty that will always lose money?  Free-at-the-point-of-use might be the current tagline for the NHS, but scratching away the surface of these reforms shows a future health service based primarily on cost over quality, and viability in a market over patient care and clinical excellence.

But this, sadly, is the reality of the present. It will be interesting to see if the electorate, and their own grassroots, forgive the Liberal Democrats for agreeing to back the bill against huge opposition, but the question remains – if Labour win in 2015, what should we do? An apparently radical idea would be to listen to the clinicians whose vocation it is to provide excellent patient care in the best and most coordinated way possible. This includes GPs, of course, but also includes hospital doctors, nurses, physiotherapists and the thousands of allied healthcare professionals who work with them.

Management is always going to get a bad name when it comes to the NHS – but the way to solve that is not to simply move it around, from PCT to consortia. Instead, a proper review of potential efficiency must be undertaken, with input not just from consultancy firms but from people who use and work with the system, and have seen more reforms than I’ve had hot dinners. A huge organisation like the NHS needs evolution, not revolution; and certainly not costly revolution.

Labour cannot simply state it will repeal the bill; we must work with the service to remove the dangerous parts, reform the bad parts, and reinforce the good parts of our NHS, and provide the service that Aneurin Bevan first conceived of so many years ago, and which the current reforms dangerously threaten.

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Charlie Bell is a medical student at the University of Cambridge and is an active member of the local Fabian Society

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Photo: Tony Roberts