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White paper responses

See the CSP's set of responses to recent government consultations on their health white paper 'Equity and Excellence: Liberating the NHS'.

CSP responses to:

  • Liberating the NHS
  • Regulating Healthcare Providers
  • Transparency in Outcomes
  • Commissioning for Patients
  • Local Democratic Legitimacy in Health

are available as PDF downloads at the foot of this page


Summary of CSP response

Our summary response to the health white paper is given immediately below:

  1. The White Paper proposals represent a high-risk strategy. CSP has grave concerns about the scope and speed of the structural changes proposed and the resulting major risks to patient care. We are also deeply concerned that the proposed shift to GP-consortia-led commissioning and plurality of providers may fragment patient care, create a 'postcode lottery' increasing health inequalities and increase costs. We urge the Government to reconsider its approach.
  2. The current pressure on the Health Service to make substantial efficiency savings will inevitably impact on its ability to introduce what could be the biggest organisational change it has experienced, since its inception in 1948, at the same time.
  3. The NHS is currently, in many areas, providing a good service, with positive elements that should not be put at risk.
  4. The White Paper poses threats to the rights of NHS staff to their national pay, terms and conditions and pensions. There is well established research linking quality employment to quality care which supports CSP's view that changes to these employment rights will have implications for the quality of patient care in the future.
  5. We urge the Government to put these proposals to full public consultation and to slow down the timeframe for the proposed changes to allow pilot schemes to be carried out to ensure the fundamental principles are right.
  6. Commissioning of health care is an immensely complex activity. It requires a wide range of clinical expertise, and highly robust data.
  7. Some areas of the existing system have been slow to embrace this complexity and achieve high standards but that does not imply failure of the system or the need for radical change.
  8. There is a lack of evidence that the proposed system will provide improvement.
  9. There are considerable concerns that effective workforce planning, including education for professions, will be further damaged by the proposals.
  10. The timescale for implementation and the financial stakes are monumental challenges.
  11. GP consortia will require considerable input from a number of clinical professional groups if they are fully to grasp the breadth of issues of service provision.
  12. There is no evidence that increased competition will increase quality or innovation in health care delivery and our concern is that the proposals will have the opposite effect.
  13. The current proposals provide no reassurance that there will be more robust attention paid to clinical quality or workforce standards in the plural provider system.
  14. The rapid removal of all the mechanisms to manage or influence the NHS's expenditure of £110 billion to be replaced by only one regulator, the NHS Commissioning Board, seems to be a major risk of fragmentation and postcode lottery.
  15. Consortia of General Practitioners may have difficulty in accepting the role to ration health care provision.
  16. There is a lack of clarity over how small scale and highly specialised clinical services will be commissioned.
  17. CSP is keen to enter into constructive dialogue and work with the Government to seek solutions to address our concerns.


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