The coalition’s NHS reforms will result in “significant institutional upheaval” without changing its aims, a group of MPs has claimed.
In a damning report from the cross-party Commons Health Select Committee, MPs including Chair, Stephen Dorrell, said they were “surprised” by the “significant policy shift” between the promises made by the coalition in May and the plans set out in its health white paper in July.
In particular, the committee outlined concerns about the abolition of primary care trusts in favour of GP-led consortia, stating that the decision had “come as a surprise to most observers”, creating uncertainty and increasing the risks and costs associated with such an upheaval.
They added that ministers have also failed to show that the plans represent the most “efficient” way of delivering good patient care.
The report comes ahead of the publication of the Health and Social Care Bill detailing a radical overhaul of the NHS, which will see most of the organisation’s budget passed to GPs, who will take control of commissioning services for patients.
The plans have been denounced by six health service unions – including the British Medical Association and the Royal College of Nursing – as “potentially disastrous”.
According to the report from MPs, the coalition programme outlined an “evolution” of existing bodies in the NHS.
However, the white paper “proposes a disruptive reorganisation of the institutional structure of the NHS which was subject to little prior discussion and not foreshadowed in the coalition programme”.
“The committee does not believe that this change of policy has yet been sufficiently explained given the costs and uncertainties generated by the process.”
A further recommendation put forward by the report is a need for “effective and accountable commissioning”, with GPs taking a principal role in commissioning while not acting alone and sharing ultimate responsibility for commissioning decisions with colleagues.
While supporting the objectives for the health service, the MPs said the priority for the NHS was to find £15 billion to £20 billion in “efficiency savings”, as ordered by NHS chief executive David Nicholson.
This is already something that is “extremely challenging” and so the failure to properly plan for upheaval in the NHS is of “particular concern” in the current financial context.
“The Nicholson challenge was already a high-risk strategy and the white paper increased the level of risk considerably without setting out a credible plan for mitigating that risk,” the MPs said.
Responding to the Health Committee’s report Dr Laurence Buckman, Chairman of the British Medical Association’s GP’s Committee, warned that the potential benefits of clinically-led commissioning may be lost due to the speed of the reforms and key parts of the Heath and Social Care Bill which make “collaboration between doctors very difficult” due to “the government’s insistence on ratcheting up competition”.
“GPs must be confident that if they choose to work with consultants from the local hospital because it enables integrated pathways to be developed, rather than a private sector organisation, it won’t be viewed as anti-competitive and therefore subject to a legal challenge,” he said.
Copyright © Press Association 2011
additional reporting by Polly Moffat