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The Health and Social Care Bill - reaction - Changes worry CSP


The unprecedented scale and speed of NHS reforms will damage patient care, the CSP’s chief executive Phil Gray warned as the Health and Social Care Bill was published on 19 January.


Mr Gray said he felt most people do not yet understand the implications of the reforms, which will see commissioning powers transfer from primary care trusts to GPs, costing up to £2bn, while trusts are tasked with saving £20bn by 2014-15.

‘The size of the health bill is much larger than any previous legislation that has been passed. The changes are huge and could potentially change the NHS beyond recognition,’ said Mr Gray.

‘I am worried that this is a massive change process alongside the challenge of saving £20bn.’

He said the changes would lead to redundancies, damage staff morale and mean less money spent on patient care at a time when there are already worries about vacancy freezes and delays to elective surgery. ‘Patient care will get damaged,’ he said.

He said the CSP was also concerned that allied health professionals will be adversely affected by the new commissioning arrangements because their services were not immediately visible to GPs.

Reforms prompt waiting list worries

Waiting lists for physio services could be driven up as a result of the NHS reforms, the CSP has warned.

Research carried out last year by the society found physiotherapy managers are already seeing waiting times increase as vacant posts remain unfilled in a bid to save money.

A report published in early January from the Care Quality Commission also warned of major gaps in the provision of rehabilitation services for thousands of stroke patients across the country.

The concern now is that the reforms, and their great cost  estimated at over £1.7 billion  will increase the pressure on physio services.

CSP chief executive Phil Gray said: ‘We recognise the need to meet the efficiency savings challenge set for the NHS but feel to add such enormous reorganisation into the mix on top of that is reckless.

‘Physiotherapists deliver absolutely essential services such as rehabilitation. The longer people have to wait for them the more likely their condition is to worsen meaning longer, more expensive courses of treatment, which only compounds the budgetary pressures already being faced.’

CSP welcomes MPs’ commissioning report

The CSP has backed warnings from MPs that the government’s restructuring of the health service is a high-risk strategy, while welcoming recommendations that a wide range of health professionals are involved in GP-led commissioning.

The report on NHS commissioning from the Commons health select committee found the plans to dismantle strategic health authorities and primary care trusts and transfer commissioning powers to GPs ‘introduces significant institutional upheaval into the NHS’ at a time when the NHS must also achieve £20bn of efficiency savings by 2014.

CSP chief executive Phil Gray said: ‘The health committee’s report reflects many of the concerns that the CSP and other health unions and professional bodies have about the scale and speed of the government’s proposed reform of the NHS.’

However, Mr Gray said the report’s emphasis on the need to create greater clinical engagement in commissioning and draw from a wide pool of practitioners was particularly welcome.

‘The CSP is urging the government to ensure that physiotherapists and other AHPs have a clear role in informing GP-led commissioning so that wide expertise is used to plan services which truly meet the needs of patients into the future,’ he said.

The committee now intends to look at the clinical expertise involved in the commissioning process.  You can read the CSP’s summary of the health committee’s report.

Spending watchdog adds to NHS concerns

The quality of services could be harmed by the planned NHS changes, says the government’s spending watchdog, the National Audit Office.

In an unusual move, it has issued a series of warnings on the major overhaul of the NHS in England outlined in the Health and Social Care Bill.

‘Our work has identified a number of undesirable results which follow from poor risk management: poorly thought-through plans, unrealistic timetables, weak controls, delays in delivery and wasted money,’ it comments about the transition process.

‘The National Health Service Landscape Review’ adds the National Audit Office’s concerns to criticisms expressed by healthcare bodies and professionals.

The review particularly raises concerns over the estimated £1.4 billion cost of the changes. It warns that major reorganisations of government departments in the past have resulted in poor cost control.

GPs could be distracted from providing patient care during the transition, as they work to establish the new consortia commissioning process, it adds.

‘The National Health Service Landscape Review’ can be found at:

The proposals for England’s NHS

restructured NHS diagram The bill will introduce major changes in the way health care is delivered. Our simplified diagram (on right) shows the main changes. The role of the Care Quality Commission will expand to include licensing as well as inspection. Monitor will continue to have a regulatory role and will promote competition.

Department of Health  The health secretary will hand over much of his current power to the new independent commissioning board and while the DH will stay it will be much smaller and will intervene less in the day-to-day running of the NHS.

 Strategic health authorities  These regional overseeing bodies will be phased out by 2013, along with PCTs.

PCTs  Local managers currently hold some 80 per cent of the NHS budget; this spending power will be transferred to GPs working in consortia around the country. PCTs will be phased out by 2013.

NHS Commissioning Board   a new statutory, independent body that will take responsibility for setting standards and holding GP consortia to account. Also expected to take charge of budgets for areas outside GP consortia control, both nationally and locally, including dentistry and specialist hospital services.

GP consortia  Pilot pathfinder projects are currently getting under way across the country, with 141 signed up so far. Lead GPs will take on budget and management responsibilities and will be encouraged to secure services from private hospitals as well as their local NHS hospital.

Hospitals  All hospitals will be expected to become self-governing foundation trusts by 2013. Nearly two-thirds have done so already.

Patients  Government wants patients to have more choice and control over their care, following the key theme: ‘No decision about me, without me’.

Bill in brief

The CSP has produced a detailed summary of the Health and Social Care Bill to help members get to grips with the key reforms the bill is seeking to legislate for. It also outlines the anticipated timeline for its implementation.


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