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.

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Richmond is a victory for hope - now let's bring change across the country

The regressives are building their armies. 

Last night a regressive alliance was toppled. Despite being backed by both Ukip and the Conservative Party, Zac Goldsmith was rejected by the voters of Richmond Park.

Make no mistake, this result will rock the Conservative party – and in particularly dent their plans for a hard and painful Brexit. They may shrug off this vote in public, but their majority is thin and their management of the post-referendum process is becoming more chaotic by the day. This is a real moment, and those of us opposing their post-truth plans must seize it.

I’m really proud of the role that the Green party played in this election. Our local parties decided to show leadership by not standing this time and urging supporters to vote instead for the candidate that stood the best chance of winning for those of us that oppose Brexit. Greens’ votes could very well be "what made the difference" in this election (we received just over 3,500 votes in 2015 and Sarah Olney’s majority is 1,872) - though we’ll never know exactly where they went. Just as importantly though, I believe that the brave decision by the local Green party fundamentally changed the tone of the election.

When I went to Richmond last weekend, I met scores of people motivated to campaign for a "progressive alliance" because they recognised that something bigger than just one by election is at stake. We made a decision to demonstrate you can do politics differently, and I think we can fairly say that was vindicated. 

There are some already attacking me for helping get one more Liberal Democrat into Parliament. Let me be very clear: the Lib Dems' role in the Coalition was appalling – propping up a Conservative government hell bent on attacking our public services and overseeing a hike in child poverty. But Labour’s record of their last time in office isn't immune from criticism either – not just because of the illegal war in Iraq but also their introduction of tuition fees, privatisation of our health service and slavish worship of the City of London. They, like the Liberal Democrats, stood at the last election on an austerity manifesto. There is a reason that we remain different parties, but that doesn’t mean we shouldn't also seize opportunities like this to unite behind what we have in common. Olney is no perfect candidate but she has pledged to fight a hard Brexit, campaign against airport expansion and push for a fair voting system – surely progressives can agree that her win takes us forward rather than backwards?

Ultimately, last night was not just defeat of a regressive alliance but a victory for hope - a victory that's sorely needed on the back of of the division, loss and insecurity that seems to have marked much of the rest of this year. The truth is that getting to this point hasn’t been an easy process – and some people, including local Green party members have had criticisms which, as a democrat, I certainly take seriously. The old politics dies hard, and a new politics is not easy to forge in the short time we have. But standing still is not an option, nor is repeating the same mistakes of the past. The regressives are building their armies and we either make our alternative work or risk the left being out of power for a generation. 

With our NHS under sustained attack, our climate change laws threatened and the increasing risk of us becoming a tax haven floating on the edge of the Atlantic, the urgent need to think differently about how we win has never been greater. 

An anti-establishment wave is washing over Britain. History teaches us that can go one of two ways. For the many people who are utterly sick of politics as usual, perhaps the idea of politicians occasionally putting aside their differences for the good of the country is likely to appeal, and might help us rebuild trust among those who feel abandoned. So it's vital that we use this moment not just to talk among ourselves about how to work together but also as another spark to start doing things differently, in every community in Britain. That means listening to people, especially those who voted for Britain to leave the EU, hearing what they’re saying and working with them to affect change. Giving people real power, not just the illusion of it.

It means looking at ways to redistribute power and money in this country like never before, and knowing that a by-election in a leafy London suburb changes nothing for the vast majority of our country.

Today let us celebrate that the government's majority is smaller, and that people have voted for a candidate who used her victory speech to say that she would "stand up for an open, tolerant, united Britain".  But tomorrow let’s get started on something far bigger - because the new politics is not just about moments it's about movements, and it will only work if nobody is left behind.

 

Caroline Lucas is the MP for Brighton Pavilion.