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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How can Britain become a nation of homeowners?

David Cameron must unlock the spirit of his postwar predecessors to get the housing market back on track. 

In the 1955 election, Anthony Eden described turning Britain into a “property-owning democracy” as his – and by extension, the Conservative Party’s – overarching mission.

60 years later, what’s changed? Then, as now, an Old Etonian sits in Downing Street. Then, as now, Labour are badly riven between left and right, with their last stay in government widely believed – by their activists at least – to have been a disappointment. Then as now, few commentators seriously believe the Tories will be out of power any time soon.

But as for a property-owning democracy? That’s going less well.

When Eden won in 1955, around a third of people owned their own homes. By the time the Conservative government gave way to Harold Wilson in 1964, 42 per cent of households were owner-occupiers.

That kicked off a long period – from the mid-50s right until the fall of the Berlin Wall – in which home ownership increased, before staying roughly flat at 70 per cent of the population from 1991 to 2001.

But over the course of the next decade, for the first time in over a hundred years, the proportion of owner-occupiers went to into reverse. Just 64 percent of households were owner-occupier in 2011. No-one seriously believes that number will have gone anywhere other than down by the time of the next census in 2021. Most troublingly, in London – which, for the most part, gives us a fairly accurate idea of what the demographics of Britain as a whole will be in 30 years’ time – more than half of households are now renters.

What’s gone wrong?

In short, property prices have shot out of reach of increasing numbers of people. The British housing market increasingly gets a failing grade at “Social Contract 101”: could someone, without a backstop of parental or family capital, entering the workforce today, working full-time, seriously hope to retire in 50 years in their own home with their mortgage paid off?

It’s useful to compare and contrast the policy levers of those two Old Etonians, Eden and Cameron. Cameron, so far, has favoured demand-side solutions: Help to Buy and the new Help to Buy ISA.

To take the second, newer of those two policy innovations first: the Help to Buy ISA. Does it work?

Well, if you are a pre-existing saver – you can’t use the Help to Buy ISA for another tax year. And you have to stop putting money into any existing ISAs. So anyone putting a little aside at the moment – not going to feel the benefit of a Help to Buy ISA.

And anyone solely reliant on a Help to Buy ISA – the most you can benefit from, if you are single, it is an extra three grand from the government. This is not going to shift any houses any time soon.

What it is is a bung for the only working-age demographic to have done well out of the Coalition: dual-earner couples with no children earning above average income.

What about Help to Buy itself? At the margins, Help to Buy is helping some people achieve completions – while driving up the big disincentive to home ownership in the shape of prices – and creating sub-prime style risks for the taxpayer in future.

Eden, in contrast, preferred supply-side policies: his government, like every peacetime government from Baldwin until Thatcher’s it was a housebuilding government.

Why are house prices so high? Because there aren’t enough of them. The sector is over-regulated, underprovided, there isn’t enough housing either for social lets or for buyers. And until today’s Conservatives rediscover the spirit of Eden, that is unlikely to change.

I was at a Conservative party fringe (I was on the far left, both in terms of seating and politics).This is what I said, minus the ums, the ahs, and the moment my screensaver kicked in.

Stephen Bush is editor of the Staggers, the New Statesman’s political blog.