Medical professionals have warned that the government's proposed reform of the NHS is "extraordinarily risky", ahead of the publication of the flagship bill on Wednesday.
The report, by the NHS Confederation, made up of the British Medical Association, the Faculty of Public Health and royal colleges representing general practitioners, hospital doctors and surgeons, accepts the need for reform but expresses grave concerns.
Broadly, the criticisms it levels fall into two categories – the handling of the reform, and its actual content.
On the first note, the Health Secretary, Andrew Lansley, is criticised for failing to convince patients or medical professionals of the need for reform – important given that this is the biggest restructuring of the NHS since its inception. "The absence of any compelling story about why the reforms are necessary or how they will translate into improved outcomes is of concern," it says.
The government's attacks on NHS managers also come under fire for being "unpleasant and demotivating". The plans focus on giving control of NHS budgets to GPs and cutting down on middle managers, meaning that managers will be expected to drive through reforms while also being purged.
Even more worrying, though, is the second "category" – the potentially negative consequences of the bill. The report notes that the switch to a system where GP consortiums can send patients to whoever offers them the best service will force the NHS to shrink to make space for new private health-care providers.
The government's argument is that introducing market mechanisms will improve quality of care and efficiency. The report concedes that this can be the case, but warns: "This will not happen naturally when, as in the case of the NHS, the size of the total market is not increasing. Closure of existing services will be necessary."
Lansley's policy of "price competition", which will allow hospitals to compete for patients, is also alarming. The NHS Confederation analysis shows that it could jeopardise standards of care.
The report's parting shot is that it is "extraordinarily risky" to restructure the NHS when it also has to save £20bn by 2014-2015.
Overall, the impression is of a poorly thought-through bill that could have hugely damaging results for free and equal health care. David Cameron is to give a speech tomorrow, aimed at allaying the fears of the medical profession and reassuring health professionals that the reform plans will not be rushed. We must hope that he listens to their concerns.