The health secretary, Andrew Lansley, today defended the government’s controversial reforms to the NHS in the face of mounting pressure from professional bodies and health unions.
Lansley underlined the Conservative commitment to the NHS, saying the party wanted to turn it into one of the world’s “great health systems”, “true to its values, but fit for the future”.
He outlined plans to turn healthcare provision into the “largest social enterprise in the world”, but health professionals warned that signalled further fragmentation of the NHS and could strip it of expertise and healthcare of its public service ethos.
Lansley – whose party reassured health workers in the run-up to the general election that there would be no further sweeping, “top-down” reforms of the NHS – also reiterated what he said were the merits of handing control for commissioning budgets to GPs and scrapping primary care trusts.
He reminded delegates at the Conservative conference in Birmingham that the government had promised to increase NHS funding year on year despite the budget deficit.
“We will not make the sick pay for Labour’s debt crisis,” he said, but warned that the financial deficit meant ministers could not “sit back” and put more taxpayers’ money into an unreformed system.
He said ministers would not “delay or dither” in taking action to ensure the NHS delivered the quality of care expected in return for the amount of money committed to it.
And he defended the decision to give GPs control over budgets “because family doctors see patients every day, they know where services are failing and they will fight for best care possible for their patients”.
Under the plans, groups of GPs will control 80% of all NHS health spending and commission services for patients from 2013. PCTs, the NHS trusts that currently manage the funds, will be abolished.
Patients would have the choice of doctor and treatment from a range of providers that met NHS standards and cost the same or less.
“That means any social enterprise, charitable organisation, public or independent provider – has the right to choose where to be treated at any provider, in what will become the largest social enterprise in the world,” Lansley said.
Doctors have questioned the speed and cost of Lansley’s plans and warned of a possible “erosion of the crucial relationship” between doctors and patients.
The Royal College of GPs (RCGP) raised “grave” concerns about the use of private companies to run NHS services and the loss of expertise in existing NHS trusts.
It said: “Many GPs are concerned that a system of GP commissioning will lead to the erosion of the crucial relationship between GPs and their patients.”
Responding to public consultation on the government’s Liberating the NHS white paper, it warned that any threat to the trust between doctor and patient “will have widespread repercussions in the effective uptake of services and clinical interventions, and ultimately on perceptions of the NHS as a whole”.
The RCGP said it supported the government’s aim of cutting bureaucracy and improving efficiency, but its members questioned the costs of the new plans and said they could result in a more expensive system.
“Members are sceptical that the reforms outlined in Liberating the NHS will save money, in either the short or the long term,” its response said.
“There are enormous costs associated with reorganisation – in this case the redundancy costs of whole tiers of NHS management, as well as the likely expansion of general practice staff and facilities.”
Most RCGP members had also expressed “grave concerns about the level of engagement of the for-profit sector in the restructured NHS”. The document said private companies may bring experience but could undermine “the essential ethos of the NHS”.
The British Medical Association said it was not against the whole plan, but voiced concern that the changes could affect the service’s “stability and future”.
The Unison union warned of possible instability, saying this could have an impact on patients.
Lansley did not acknowledge the RCGP response in his conference speech, which highlighted the government’s commitment to improve patient care through reforms.
He told delegates he had cut NHS management costs by almost a half – with “every penny saved” to be reinvested into services – and set out the case for securing better value for money.
He also announced a £70m cash boost to enable the NHS to support around 35,000 people going back into their homes after spells in hospital. From April, the NHS will have new responsibilities for people’s care needs for 30 days after they leave hospital.
“This new funding will mean people will benefit right now, and around 35,000 will start to get the help and support they need, to allow them to be once again independent in their own homes,” Lansley said.
The measure is expected to save money for health and social care by preventing costly hospital readmissions.
“Too many patients don’t get the seamless effective service they should when they leave hospital,” Lansley said. “They leave an environment in which they have been cared for around the clock to go home, sometimes alone, with no help.
“Too often, they end up back in hospital because they haven’t had help readjusting to life at home. In fact, we’ve seen a 50% increase in the number of emergency readmissions in the 10 years from 1998. We need to do more to prevent this from happening.”
The Guardian UK