With the government pushing ahead to radically reform the NHS, managers warn that the health service could worsen instead of improve. By introducing competition based on price rather than quality, could see NHS services becoming a postcode lottery. 

The NHS Confederation, which is highly critical of the government’s proposal to reform the NHS, said, “There are significant risks in the government’s plans, as well as an absence of detail regarding how they will be implemented.”

“The drive to improve local decisions will mean more variability of access to services, while competition based on price is likely despite ministers’ assurances.”

This latest criticism comes at a time when a new survey of GPs found that 75% of GPs surveyed want limits placed on the involvement of the private sector in healthcare and more than half have no confidence in the Health Secretary, Andrew Lansley.

Nigel Edwards, acting Chief Executive of the NHS Confederation, said, “The government has got to ask itself some hard questions about how it manages the reforms from here on in.”

“The debate on the reforms has become very polarised and entrenched, with little movement on the practical ways of managing what are very significant risks. This is destabilising for an NHS that is already making structural changes to meet the government’s agenda.”

“We have often found a reality gap between ideas that are good in principle and the details of practical delivery, which have often looked opaque or too optimistic.”

The Health and Social Care Bill that is currently going through Parliament will see the control of £80 billion of the NHS budget being passed to GP-led bodies who will then decide on how that money is spent on patient care – including opening up competition from private health care providers. 

On top of the government’s reform, which will see £80 billion of the NHS’s budget being passed over to GP Consortia, the NHS is under pressure to save £20 billion over the next three years through efficiency saving measures. The net result of this is likely to see jobs go across the NHS including midwives, nurses, doctors, GPs and GP Locums. 

So far the government’s reform bill has come under strong criticism from doctors, nurses, coalition Liberal Democrat MPS as well as opposition Labour MPs, fuelling rumours that ministers will be forced to make u-turns on parts of the most contentious proposals. 

In a paper published by the NHS Confederation, they are highly critical of the government’s failure to explain the reforms in sufficient detail. On the introduction of a free market, the Confederation says, “The right sort of competition can lead to improvements in care, but ministers need to make the arguments more confidently and have failed to set out whether or not GPs and hospitals can collaborate.”

“It says the government has insisted that private providers will not be allowed to undercut state-run hospitals but points out that only about two-thirds of services are covered by set tariffs, so price competition remains possible, indeed likely in mental health, specialist hospital care and community services.”

The Confederation went on further to say, “It is highly questionable whether or not every service should be up for grabs, particularly in the provision of complex treatments for long-term health conditions that require co-ordination, and that the government’s plans are insufficiently sophisticated.”

“There are also legitimate concerns that GPs could have conflicts of interest if they are both commissioning and providing treatment, and may personally benefit from rationing care.”

“Plans for greater accountability, meanwhile are vague and need much-needed clarity.”

“At the same time, there are significant risks during the transition to the new regime including a possible loss of grip on money and quality, and essential communications have been lacking.”

Dr Hamish Meldrum, Chairman of Council of the British Medical Association, said, “if the Bill is to be enacted it is essential that there are very significant changes to remedy its many problems, in order to avoid or, at the very least, limit the potential damage to the NHS.”

The Health Secretary, Andrew Lansley, said, “The NHS Confederation is one of a number of organisations across the NHS that are now focussing on specific amendments, having supported the principles of out modernisations plans.”

“We have common objectives and welcome input from the NHS Confederation. It helps to bring more clarity to the detail of our comprehensive modernisation plans.”

With the government’s NHS reform bill being far from being enacted, this latest round of criticism highlights the medical professions concerns over the future of the NHS. Critics argue that the bill is ill planned and will see patient care suffering as a result of the reforms, as well as possible future NHS jobs losses. 

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