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First response

Could pushing through untested proposals for the NHS result in a government slip-up? Sally Priestley reports

Since the coalition government launched its controversial White Paper on NHS reform in July, healthcare and medical groups and unions have been busy working on response papers, aimed at making their voice heard in the increasingly rowdy debate. The consultation period closed on 11 October and the media has been awash with argument, lobbying and political fire-fighting prompted by responses from across the sector. Equity and Excellence: Liberating the NHS promises to make the NHS more accountable to patients, put patients at the heart of the health service, focus on outcomes and empower health professionals. It proposes massive restructuring of the NHS and reforms to delivery of care and services in England. One of the headline plans will see PCTs phased out by 2013. This would result in the scrapping of tiers of management. Additionally, a huge slice (around 80 per cent) of the NHS budget will be given over to GPs to oversee their own spending and buy care from hospitals and other doctors. In its response the CSP has registered major concerns over the breadth of the changes and the speed at which they are set to take shape. The Society called for pilot studies ‘to ensure that quality of care to patients will not be compromised’. And on the proposed spending and commissioning arrangements, chief executive Phil Gray said he was concerned the paper could ‘open the door to an unacceptable postcode lottery’. ‘A situation could be created whereby these essential services are available to some but not to others, so the government must re-think its plans,’ he added. Other concerns include the difficulty for staff in bringing about the required £20 billion of efficiency savings alongside such huge structural change. The British Medical Association is strongly critical of many aspects of the planned reforms. While there were positive elements in the proposals, such as devolving more control to patients, the BMA said there were risks in the market-based approach.

Stronger support   

Describing the plans as potentially damaging, the BMA said they risked setting groups of clinicians against each other. The Association also expressed deep concerns over the move to force all hospital trusts to become semi-independent foundation trusts, saying the creation of foundation trust status had ‘already threatened the character and ethos of NHS provision’. Meanwhile, the Royal College of General Practitioners said it supported stronger clinical leadership for commissioning patient services, but stressed training, time and resources would be necessary. ‘The principles of greater GP leadership and influence are well received’, the college said, but members were concerned that ‘the proposed scale, pace and cost of change will prove disruptive’. The surgeons said that if the health service reforms were to work, partnerships between primary and hospital clinicians were essential. ‘The emphasis on outcomes and a move away from process targets can only improve care,’ the RCS said. But it warned that with the new spending set-up ‘it is vital that hospitals are properly incentivised to maintain medically important but financially demanding services’. The scale and speed of reforms posed a ‘significant risk to the future of the NHS in England’ and the structural reforms should be piloted, according to the Royal College of Nursing. While welcoming the principles of the White Paper, the nursing body warns that pushing through untested proposals without staff support could lead to a break up of part of the NHS, with the resulting impact on patient care and services. National pay arrangements should stay and NHS pensions be protected, the RCN added. Fl Read the CSP response at http://tinyurl.com/34vm3pp

POINTS:

  • more competition in delivering services
  • focus on outcomes and quality, and the removal of targets without ‘clinical justification’
  • responsibility for most commissioning to GPs
  • an independent NHS commissioning board; abolition of SHAs and PCTs
  • reduction in the number and complexity of NHS bodies and management
  • more chances for employers to break away from national terms and conditions of employment
  • increased decision-making for patients, including control over records, choice of healthcare
  • provider and personal budgets.

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