The National Health Service (NHS) in England needs to get rid of the market in healthcare once and for all, British Medical Association (BMA) chairman Hamish Meldrum has told the annual conference of the doctors’ group, being held this week in Edinburgh.

After 20 years of the market in England, he asked where was the evidence that for most of what doctors do – emergency care, long-term conditions and primary care – the market improves rather than detracts? “Instead, we get competition not collaboration, fragmentation not continuity, inefficiency not efficiency,” and this was not good for doctors, for patients or for the NHS, he said.

“The BMA wants to see an NHS untarnished by a market economy, true to its beginnings, giving the public a fair, caring, equitable and cost-effective health service – not a service run like a shoddy supermarket war,” he said, in the opening speech of the conference, and he called for England to follow the example of Scotland, which operates without a competitive market among health care providers.

“I’m not saying that everything’s perfect north of the Border, but at least there seems to be a shared agenda, a willingness and an eagerness to pull together that you don’t see south of Hadrian’s wall or east of Offa’s dyke,” he said.

“Let’s stop pretending that healing the sick is like trading a commodity, Let’s stop diverting doctors’ energies into unholy bidding wars for jobs they already do. Let’s follow the Celtic lead and get rid of the market in healthcare once and for all. What a pity Ara Darzi missed his golden opportunity to do that.”

While devolution has always been portrayed as the three Celtic nations breaking away from England, in the case of the NHS it has been the other way round, with England breaking away from the rest of the UK, said Dr Meldrum.

Peter Terry, chairman of the BMA in Scotland, agreed that devolution has led to the creation of four different health services in the UK, with England having gone down a completely different route to that taken by Scotland, Wales and Northern Ireland. “I no longer recognise the NHS in England as the NHS as it was initially intended, where competition and privatisation drive service delivery, not the collaboration and partnership approach taken here in Scotland,” he said.

However, Dr Terry added that it had become “increasingly easy and inappropriate” to compare the Scottish NHS with that in England. “If we are to improve in Scotland, we must have more challenging comparisons outwith the UK that aspire to similar, fully-integrated, co-operative and fully publicly-funded health services,” he said.

Just ahead of the conference, the BMA published new opinion poll findings showing that 51% of the public oppose the English government’s policy of encouraging commercial companies to provide healthcare, and that 58% disagree with commercial companies making a profit for shareholders from providing NHS care.

NHS “under threat from commercialisation”

Meantime, Nobel Laureate Sir John Sulston has said that, while health care in the UK is in good shape thanks to the NHS and the National Institute for Health and Clinical Excellence (NICE), which are “hugely important” for ensuring affordable medicines, both are under threat from commercial interests. The NHS is “under threat of death from a thousand cuts,” he warned.

Speaking at the University of Manchester, at the opening of the Institute for Science, Ethics and Innovation (ISEI), which he will chair, Sir John said the UK takes up drugs at about the right rate, while American does it too easily, and he claimed that campaigns to allow patients to receive innovative drugs which may offer only marginal benefits were being driven by people who make new medicines.

“It is very clear that the present system of innovation in medicines is very inefficient and really somewhat corrupt, said Sir John, who won the Nobel Prize for Physiology/Medicine in 2002. “It benefits shareholders over patients, it produces for the rich markets and not for the poor and does not produce for minority diseases. The marketing spend far exceeds the research and development spend,” he added.