The scale and speed of the proposals outlined in the Government’s Health and Social Care Bill could destabilise the NHS, critics have warned.
The proposals include giving GPs control of up to 80% of the NHS budget and SHAs and PCTs being scrapped and turned into Foundation Trusts by 2014.
Dr Hamish Meldrum (pictured), Chairman of Council at the British Medical Association (BMA), said that committing to the reforms was “a massive gamble”.
But Health Secretary Andrew Lansley argued that modernising the health service was a “necessity not an option”.
“We need to take steps to improve health outcomes, bringing them up to the standards of the best international healthcare systems, and to bring down the NHS money spent on bureaucracy,” he said.
“This legislation will deliver changes that will improve outcomes for patients and save the NHS £1.7 billion every year – money that will be reinvested into services for patients.”
Under the plans more than 150 NHS organisations will be abolished as GPs take on responsibility for commissioning local services to improve patient outcomes. The BMA says it supports a greater involvement for clinicians to plan NHS services but other parts of the Bill threaten the benefits of clinical-led commissioning. It highlights that under the proposals competition will be forced upon commissioners, even if they believe the best services can be provided by hospitals.
“Forcing commissioners of care to tender contracts to any willing provider, including NHS providers, voluntary sector organisations and commercial companies, could destabilise local health economies and fragment care for patients,” said Dr Meldrum.
“Adding price competition into the mix could also allow large commercial companies to enter the NHS market and chase the most profitable contracts, using their size to undercut on price, which could ultimately damage local services. Dr Meldrum added that forcing trusts to achieve foundation status before they are ready could impact on patient levels of care. He said the BMA would lobby very hard to amend “the most damaging aspects of this legislation”.
Chris Ham, Chief Executive of The King’s Fund, said the proposals could ‘destabilise’ the health service, calling the Bill the “biggest shake-up of the NHS since its inception”.
“The last decade has seen significant progress in the performance of the NHS,” he said. “While ministers are right to stress the need for reform to make it truly world class, these gains are at risk from the combination of the funding squeeze and the speed and scale of the reforms as currently planned.
“But, while the Government’s reforms have the potential to improve the NHS, they will be implemented against the backdrop of the biggest financial challenge in its history. Finding the £20 billion in efficiency savings needed to maintain services must be the overriding priority, so the very real risk that the speed and scale of the reforms could destabilise the NHS and undermine care must be actively managed.”
Ham said the Government should instead adopt a flexible approach to implementing the reforms and that MPs and peers should understand the difference between well executed changes that deliver results and those which will undermine the NHS as they continue to debate the Bill in Parliament.