Some of the government's policies aimed at improving services for patients could end up harming patients' interests, warned Dr Paul Miller, chairman of the BMA's consultants' committee at the association's annual conference of senior hospital medical staff in London this week.
Dr Miller acknowledged the massive financial investment in the NHS that the current government had made. But he went on to say that earlier BMA predictions that new style NHS providers, in particular treatment centres, would destabilise the NHS were coming true.
He cited the impact that an independent treatment centre in Southampton had had on NHS facilities. "A large amount of elective orthopaedics was transferred from the NHS to the independent sector treatment centre—nothing to with the choices of patients, everything to do with following political orders.
"Consequently, Southampton had to plan the inevitable closure of a ward and staff redundancies. And I hear that some of the patients are too complex for the treatment centre. But the NHS unit is no longer available, so they are in limbo and do not even appear on any published waiting list."
He added that although various secretaries of state had said that they would not force patients to go to hospitals that they didn't want to, the exact opposite was happening in Southampton, where patients were, he said, being forced to "go anywhere but the Southampton unit they might have chosen."
He argued that treatment centres were, inevitably, cherry picking the easiest and cheapest patients. "They simply do not have the resources, such as out of hours staff and [intensive care] beds to do the more difficult cases," he said.
And the fact they were doing the straightforward procedures was also having a knock-on effect on future surgeons' training, he said, and was a "scandalously short sighted approach." It was also biasing the case-mix within the NHS, which was having an effect on research, he added.
The money spent on contracts for services with private companies did not represent good value for money, Dr Miller said. "Just imagine how much the NHS could have achieved if these enormous amounts of money had been directed at mainstream NHS clinical services.
"Last year the NHS still delivered 96% of the cataract operations which were done, and of course 100% of the care for patients in [emergency departments], obstetrics, cancer, mental health, paediatrics, etc."
He said that BMA consultants remain concerned about poor quality and uncertain clinical governance arrangements in these novel independent sector schemes. And he insisted that it was the threat to patients, rather than to the profession, that concerned him most."The problems I have been seeing with patient services in treatment centres make me truly believe that the NHS is not only worth protecting and cherishing, it is the most important and valuable piece of social capital in our country."