Controversial reforms to the health system in England are set to be passed into law after a final attempt to postpone their implementation was defeated in parliament.
A call from shadow Health Secretary, Labour’s Andy Burnham, to block the Conservative/Liberal Democrat government’s Health and Social Care Bill until a risk register containing potential negative consequences of the reforms was published was voted down by MPs yesterday by 328 votes to 246.
The Bill, which has faced criticism from many UK healthcare groups, had already been passed by both the House of Commons and the House of Lords after undergoing numerous amendments over the last 14 months.
It sets out the biggest set of changes to the NHS in England since it was founded more than 60 years ago. These include handing commissioning powers to GPs by establishing clinical commissioning groups (CCGs) and abolishing primary care trusts and strategic health authorities. The new CCGs will be held to account by an independent NHS Commissioning Board.
Borrowing restrictions on NHS Foundation Trusts will be removed; the cap on private patient income cap will be lifted; and public health responsibilities will be given to local councils.
The most debated reforms have concerned the widening of competition within the system, which many critics say opens the NHS up to privatisation.
Such concerns have led to numerous attempts from Health Secretary Andrew Lansley to appease the Bill’s opponents, including the launch of healthcare stakeholder group the NHS Future Forum to discuss the reforms.
The groups’ advice has led to a larger number of recommendations accepted by the government in January, 2012, concerning such areas as integration, education and public health.
The UK’s National Institute for Health and Clinical Excellence (NICE) was also able to retain its responsibility to recommend drugs and treatments for use on the NHS thanks in part to advice given by the Future Forum.
However, despite these amendments, most bodies representing the NHS remain opposed to the Bill, citing concerns about the speed of change, the complexity of the reforms, unanswered questions as to its consequences and a divergence in between what the government is saying and what the Bill really means.
Responses include:
Royal College of Nursing
Chief Executive & General Secretary Dr Peter Carter said: “This is, however, a deeply flawed bill that we have repeatedly raised concerns about. We have achieved some concessions which make it a different piece of legislation from that which first appeared, but our real concerns about the future of the NHS have not been heeded.”
Royal College of General Practitioners (RCGP)
RCGP chair Dr Clare Gerada said: “The college has made its opposition to the Bill well known, but we have also been very clear on the distinction between the Bill in isolation, and the importance of the role of GPs in the planning and delivery of local services. Now that this Bill is set to become law we will support GPs in using their existing skills to ensure patients continue to receive excellent care.”
British Medical Association
Dr Hamish Meldrum, chair of the BMA’s Council, said: “The Health and Social Care Bill is not fit for purpose and it would be far better for the NHS if it were withdrawn. We want the Government to work with healthcare professionals so an alternative solution can be developed, one which has the support of NHS staff and the public.”
General Practitioners Committee (GPC) (part of the BMA)
GPC chairman Dr Laurence Buckman said: “I’m very concerned about what buying in commissioning support will mean for CCGs and how much control these support services will end up exerting. If they’re run by the private sector we could end up with the de-facto privatisation of commissioning support.”
UK’s Faculty of Public Health
Professor Lindsey Davies, President of FPH, said: “The bill will increase health inequalities because there is the real danger that vulnerable groups like homeless people will not be included when health services are being planned. Clinical commissioning groups and service providers will be able to pick and choose what procedures they perform and which services they put in place.”
The Royal College of Physicians also released a survey just before the Bill passed saying 69 per cent of members would reject the Bill as it stood.
More sympathetic groups included the Royal College of Psychiatrists, which welcomed the government’s decision to retain an amendment to better integrate mental and physical health.
“We hope that this duty on the Secretary of State can help to ensure ‘parity of esteem’ between mental and physical health can be achieved at every level, from national policy to local planning in the NHS, social care services and public health,” said the body in a joint statement with several mental health charities.
Mike Farrar, chief executive of the NHS Confederation, the membership body for all organisations that commission and provide NHS services, said this was “the beginning, not the end” and that NHS leaders should focus on implementing the reforms as efficiently and effectively as possible, rather than remain in opposition.
“We need to heal the rifts that have opened as many of our clinical staff have debated the merits of the Bill. The Government should start by giving them a compelling narrative for implementing these reforms.”
“We need to completely redesign NHS services against a backdrop of unprecedented financial pressure, bringing the public and staff with us.”
However, Labour’s Burnham remained defiant that his party would attempt to reverse the reforms if elected into power at the next general election.
He said: “While on a day like today it’s hard for me to give any encouragement to people worried about what this government is doing, I can at least say this: that we will repeal this bill at the first opportunity and restore the N in NHS.”
The Bill is due to come into force some time in the next couple of weeks before Easter.