The Lords should remember this: no-one voted for these NHS changes

As today's letter to the Independent newspaper from leading clinicians makes clear - coupled with the announcement from the BMA that they remain opposed to the Bill in its current form -  there is huge disquiet amongst health professionals with the legislation as it stands,  including senior medical staff not known for engaging in politics.

Moreover, the evidence base upon which the Bill is based is weak and its proposals ill-though out. In fact, empirical evidence has demonstrated rising, not falling, satisfaction amongst the British people (in numerous different surveys) with the quality of care in the NHS and - as the Commonwealth Fund demonstrated - the health service performs strongly in comparison to those of most other developed countries' health systems.

Evidence also points to the fact that investment in the NHS has resulted in improved standards of care. Crucially, although some of the challenges outlined by supporters of the Bill do indeed exist - rising health costs, increasing demand, the causes of these are in fact common to health systems of all hues, including insurance-based models. These include the increasing costs associated with medical technology and the significant demographic changes the western world has seen over the past half century.

The solution that this Bill proposes is therefore flawed in four different ways: it lacks support (and has plenty of opposition) amongst health professionals; the base of evidence on which it is based is limited; it has many aspects that could create huge practical difficulties and, finally, in defending the Bill, its supporters seek to attribute problems that health systems of all hues are facing to be those particular to the National Health Service.

This Bill lacks a democratic mandate, it lacks public and professional support, it has fundamental flaws and - most damagingly for our democratic processes - its path so far through Parliament has been marked by a lack of sincere and rigorous examination that a Bill of such magnitude deserves.