Medical professionals warn against “extraordinarily risky” NHS reform

Coalition’s flagship Health and Social Care Bill could cause health service to shrink and jeopardise

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.

Samira Shackle is a freelance journalist, who tweets @samirashackle. She was formerly a staff writer for the New Statesman.

Getty
Show Hide image

The SNP thinks it knows how to kill hard Brexit

The Supreme Court ruled MPs must have a say in triggering Article 50. But the opposition must unite to succeed. 

For a few minutes on Tuesday morning, the crowd in the Supreme Court listened as the verdict was read out. Parliament must have the right to authorise the triggering of Article 50. The devolved nations would not get a veto. 

There was a moment of silence. And then the opponents of hard Brexit hit the phones. 

For the Scottish government, the pro-Remain members of the Welsh Assembly and Sinn Féin in Northern Ireland, the victory was bittersweet. 

The ruling prompted Scotland’s First Minister, Nicola Sturgeon, to ask: “Is it better that we take our future into our own hands?”

Ever the pragmatist, though, Sturgeon has simultaneously released her Westminster attack dogs. 

Within minutes of the ruling, the SNP had vowed to put forward 50 amendments (see what they did there) to UK government legislation before Article 50 is enacted. 

This includes the demand for a Brexit white paper – shared by MPs from all parties – to a clause designed to prevent the UK reverting to World Trade Organisation rules if a deal is not agreed. 

But with Labour planning to approve the triggering of Article 50, can the SNP cause havoc with the government’s plans, or will it simply be a chorus of disapproval in the rest of Parliament’s ear?

The SNP can expect some support. Individual SNP MPs have already successfully worked with Labour MPs on issues such as benefit cuts. Pro-Remain Labour backbenchers opposed to Article 50 will not rule out “holding hands with the devil to cross the bridge”, as one insider put it. The sole Green MP, Caroline Lucas, will consider backing SNP amendments she agrees with as well as tabling her own. 

But meanwhile, other opposition parties are seeking their own amendments. Jeremy Corbyn said Labour will seek amendments to stop the Conservatives turning the UK “into a bargain basement tax haven” and is demanding tariff-free access to the EU. 

Separately, the Liberal Democrats are seeking three main amendments – single market membership, rights for EU nationals and a referendum on the deal, which is a “red line”.

Meanwhile, pro-Remain Tory backbenchers are watching their leadership closely to decide how far to stray from the party line. 

But if the Article 50 ruling has woken Parliament up, the initial reaction has been chaotic rather than collaborative. Despite the Lib Dems’ position as the most UK-wide anti-Brexit voice, neither the SNP nor Labour managed to co-ordinate with them. 

Indeed, the Lib Dems look set to vote against Labour’s tariff-free amendment on the grounds it is not good enough, while expecting Labour to vote against their demand of membership of the single market. 

The question for all opposition parties is whether they can find enough amendments to agree on to force the government onto the defensive. Otherwise, this defeat for the government is hardly a defeat at all. 

 

Julia Rampen is the editor of The Staggers, The New Statesman's online rolling politics blog. She was previously deputy editor at Mirror Money Online and has worked as a financial journalist for several trade magazines.