The government’s radical shakeup of the NHS threatens its future, may not improve patient care and could usher in a two-tier health service, doctors’ leaders warn today.
In a strongly worded intervention, the British Medical Association casts serious doubt on the huge reorganisation of the NHS in England unveiled in health secretary Andrew Lansley’s white paper in July. The doctors’ union argues that Lansley’s plans are potentially damaging, risk setting groups of clinicians against each other and are not a good use of public money when the NHS has to save £15bn-£20bn.
“There are aspects of the white paper’s proposals which have the potential to undermine the stability and long-term future of the NHS,” the BMA warns in its submission to the Department of Health. Critics of Lansley’s strategy have warned that the measures will spell the end of the NHS in its present form.
The BMA adds that forcing all hospital trusts to become semi-independent foundation trusts – another key element of Lansley’s plans – will prove damaging.
“Changing the status of existing NHS providers to foundation trust status has already threatened the character and ethos of NHS provision. Further moves towards the deployment of corporate entities would threaten the stability of the NHS and the security of its employees and their terms and conditions of service,” it says. About half the hospital trusts in England have become foundation trusts, which are free of most Whitehall control.
The submission casts serious doubt on many of the policies which Lansley insists are vital to improve NHS performance, reduce bureaucracy and improve the outcomes of treatment for patients.
In a robust message to Lansley, the BMA adds: “We urge the government and NHS organisations to focus on those areas where they can truly eliminate waste and achieve genuine efficiency savings rather than adopt a slash-and-burn approach to health care, with arbitrary cuts and poorly considered policies.”
The BMA’s stance poses a major problem for Lansley, who has sought to win the profession’s backing by stressing that family doctors will gain unprecedented autonomy, extra influence over their patients’ treatment and control of £80bn of the NHS budget through a switch to GP-led commissioning of healthcare.
Dr Hamish Meldrum, the BMA chairman, said that doctors approved of some measures, such as patients having more say and a greater focus on outcomes. “But there is also much that would be potentially damaging. The BMA has consistently argued that clinicians should have more autonomy to shape services for their patients, but pitting them against each other in a market-based system creates waste, bureaucracy and inefficiency.”
The health secretary said he welcomed the BMA’s response.
“They agree that general practice-led commissioning is the best place to manage patient care. Doctors are clear through the BMA that the way forward is to focus on patients, on outcomes, and on devolved decision-making.
“If we are going to manage resources more effectively, the clinicians that are making the biggest decisions with the biggest impact – referral and prescribing – need to be the same clinicians who know best how two things come together,” he added.
Many GPs across England were keen to switch to the new system quickly, he added, although others still needed more information before they could make up their minds.
Andy Burnham, the shadow health secretary, seized on the BMA’s submission as vindication of Labour’s determined opposition to the white paper. “This is a humiliating blow for Mr Lansley and his plans. Doctors are telling him in no uncertain terms that his proposals will damage the NHS,” said Burnham, who has warned that the changes would “unpick the very fabric of our NHS and turn order into chaos”.
“This surely sounds the death knell for these ill-conceived plans,” added Burnham, who said that Lansley’s failure to win the backing of both the BMA and the Royal College of GPs meant David Cameron should put the plans on hold. “Listening to medical professionals is his holy grail – so now he must listen, and act, because those professionals have rejected his plans,” said Burnham.
The Guardian uk