Health chiefs issue stark warning over damaging effect of NHS reforms
guardian.co.uk, Saturday 15 January 2011 22.00 GMT
Hospitals will have to close, patient care could be hit and treatment rationed by GPs because of the government's controversial shake-up of the NHS, health bosses and medical leaders have warned.
The biggest restructuring of the service since its creation in 1948 is described as "extraordinarily risky" by NHS leaders and medical groups in a new report.
The analysis by the NHS Confederation – comprising the British Medical Association, the Faculty of Public Health and the royal colleges representing GPs, surgeons and hospital doctors – comes ahead of publication of the government's flagship Health and Social Care Bill on Wednesday.
The report accepts the need for reform but criticises the health secretary, Andrew Lansley, for failing to persuade patients and health professionals that his radical proposals to hand the power to commission services to GPs will improve the NHS, and for not doing enough to boost patient power. Their intervention is another blow to Lansley, whose overhaul of the NHS in England has been criticised as unnecessary, reckless and too far-reaching.
On Monday, amid anxiety about the plans in the Tory-Liberal Democrat coalition, David Cameron will deliver a speech in which he will try to soothe worries of MPs and medical professionals. The prime minister is expected to say that the plans to devolve power to GPs will not be rushed and that lessons will be learned from pilot projects.
On Tuesday, Lansley will face further problems with publication of a searching report by the all-party health select committee. Sources say the committee will be "robust" in its analysis and ask a string of "searching questions". The committee will recommend how the new system could deliver better value for money, given the budget restraints now facing the NHS.
Before the election the Tories promised there would be no major "top-down" reorganisation of the NHS, only to unleash proposals for the most sweeping changes for decades. The conclusions of the confederation make uncomfortable reading for Lansley.
"The absence of any compelling story about why the reforms are necessary or how they will translate into improved outcomes is of concern," states the document. It also criticises ministers' "unpleasant and demotivating" attacks on NHS managers, whom they are purging while expecting them to drive through the reforms.
There is also disquiet in Lib Dem ranks. One senior Lib Dem said the Lansley project was a leap in the dark: "There are three scenarios: it could be a disaster; it could be just about OK; or it could work. I can't think of a major reform where so many have regarded the outcome as so uncertain."
The prime minister is now said to be determined to take a close interest in the passage of the NHS bill through parliament and to examine the concerns of the medical profession.
The report raises a series of worries about the potentially negative impact of the reforms. It says the switch to a system based on "any willing provider", in which new consortia of GPs will be able to send patients to whoever offers them the best treatment, will force the NHS to shrink in order to make space for new private healthcare providers.
While introducing such market mechanisms can improve quality and efficiency of care, it says, "this will not happen naturally when, as in the case of the NHS, the size of the total market is not increasing. Closure of existing services will be necessary."
The report urges the NHS to resolve "difficult questions about hospital configuration" – that is, to shut units or even entire hospitals that are no longer viable – before the GP consortia start work in 2013. Lansley's new policy of "price competition", allowing hospitals to compete for patients, also poses a risk to standards of care, it adds. The report expresses concern that the reforms are being implemented at a time of spending restraint, suggesting it is "extraordinarily risky" to be restructuring the NHS when it also has to save £20bn by 2014-15.
The shadow health secretary, John Healey, said the report was a "comprehensive demolition job" and "a big red warning light ahead of the government's legislation."
The health department said that the NHS had to play its part in creating a system "that puts patients at the heart of everything it does, focuses relentlessly on improving healthcare outcomes and liberates professionals at every level to take decisions in the best interests of patients, rather than being micromanaged by politicians and civil servants."
It added: "The Health and Social Care Bill will provide a clear legislative framework to support that ambition."
NHS reform plans risky and expensive, warn MPs on health select committee
Former health secretary Stephen Dorrell criticises 'surprise proposal' to scrap PCTs and hand commissioning to GPs
Conservative MP Sarah Wollaston, a Devon GP, said the reforms felt 'like someone had tossed a grenade into the PCTs'. Photograph: Mark Passmore/Apex
MPs today warn that the government's decision to go for rapid, root-and-branch restructuring of the NHS has made its plans for health reform both more risky and more expensive.
The report on changes in NHS commissioning from the all-party Commons health select committee says: "The committee broadly shares the government's policy objectives, so it therefore welcomes the fact that these are substantially unchanged. It does not believe, however, that the approach adopted by the government represents the most efficient way of delivering those objectives."
Central to the government's health reforms, says the committee, is the challenge laid down in 2009 by the NHS chief executive, Sir David Nicholson, to make efficiency savings of 4% per year from 2011 to 2012 – effectively £15bn-£20bn.
"The failure to plan for the transition is a particular concern in the current financial context. The Nicholson challenge was already a high-risk strategy and the white paper increased the level of risk considerably without setting out a credible plan for mitigating that risk," says the report.
Stephen Dorrell, the former Tory health secretary who chairs the committee, criticised "the surprise proposal" in the white paper last July – which had not been in the coalition's programme published in May – to scrap primary care trusts (PCTs) and hand commissioning to GP consortiums.
Describing the committee's attitude as "a critical friend", he said: "We share the government's objectives. We also say that this is in several respects not the most effective way to deliver them."
The committee will carefully scrutinise many aspects of the NHS bill, due to be published tomorrow, as it goes through parliament. In a speech yesterday, David Cameron defended the planned changes, arguing that he was on a personal crusade to make UK hospitals the best in the world. "Pretending that there is some easy option of sticking with the status quo and hoping that a little bit of extra money will smooth over the challenges is a complete fiction," he said. There was enthusiasm for the new commissioning arrangements, he said. More than 140 GP-led consortiums had now come forward, covering half the country.
The committee's report says that commissioning cannot be entirely left to GPs, who "have a major role as a catalyst for this process, but not as the ultimate arbiters of all commissioning decisions". Conservative MP Sarah Wollaston, a Devon GP, said her colleagues on the committee were all concerned about the costs of restructuring. PCTs are being asked to hold back 2% of their budgets, or £1.7bn, for what was originally termed "service transformation", but some of which is now, according to the report, being designated for management change. Wollaston said: "To my mind, it felt a bit like someone had tossed a grenade into the PCTs. These people have so much uncertainty about their position that they are haemorrhaging in a rather uncontrolled fashion. If the expertise is not there in the remains of the PCT clusters, inevitably they [GP commissioners] are going to have to be turning more to the private sector."
Sir Richard Thompson, president of the Royal College of Physicians, agreed. "We welcome clinician-led commissioning," he said. "However, hospital specialists' involvement should be mandatory to ensure the best quality care for patients."
Andrew Lansley, the health secretary, said there was "a lot of enthusiasm for our ideas". He believed the changes were evolutionary. "We are simply building on the best of what already exists – for example, GPs working in practice-based commissioning groups, foundation trusts, patient choice, and payment by results for hospital services," he said.