Monday, 7 February 2011

NHS reforms: the wave of criticism grows ever larger

It is a striking that this government has so far escaped widespread criticism amongst the general public for attempting to implement a drastic and potentially disastrous NHS reform programme in England, having won absolutely no electoral mandate whatsoever to undertake such changes.

There was no hint, even prior to the election, about such reforms, something that even the Daily Mail isn't altogether happy about. From those working in health care, though, it's a different story.
Criticism from within the health professions, from patient groups and from health think tanks has been almost uniformly negative - the Health and Social Care Bill seen variously as ideologically driven, ill-timed and potentially vastly damaging to accountability.

GP groups have been joined by trade unions and even a Tory MP (and ex-GP) in expressing significant concerns that care standards may decline, fragmentation increase and that they pave the way for a privatisation of the National Health Service.

Here is just a tast of how widespread opposition to these reforms have spread, encompassing groups not associated with centre-left politics:
The Royal College of General Practitioners has said that "these reforms could cause irreparable and irreversible damage to the NHS." This view has been vindicated by a poll of GPs that showed barely more than a fifth of GPs viewed the reforms as likely to improve patient care.

The Chair of the BMA's GPs Committee has warned in strongly worded terms that the Bill is likely to damage the prospects of 'the poor, elderly, infirm and terminally ill'. Like so many other critics of the reforms, he goes on to warn about privatisation:
"We will quite quickly see failed consortia bought up on the cheap by foreign companies and see bits of the NHS run from abroad. This really is just the beginning. Parts of this government want to see all NHS management in private hands." The BMA itself has now threatened that a strike is not off the table if the government continues to dismiss doctors' concerns.

The respected health journal, The Lancet, has gone even further in its criticisms, calling these reforms "the end of the NHS as we know it". The equally renowned British Medical Journal has expressed similar concerns.

The Royal College of Surgeons, has warned that price-competition may lead to lower standards of care, in what they describe as a 'race to the bottom'.
The Royal College of Physicians, in a similar vein, has expressed concerns about service fragmentation and damaging competition based on price, not quality.

The Kings fund has warned not only of the possible damage the reforms cause, but also criticised justification deployed by Andrew Lansley - that health outcomes in the UK are noticeably worse than in other European countries as a result of its structure.

The Royal College of Midwives has attacked the timing and nature of the reforms:
'This is a bureaucratic exercise that is about reorganising and restructuring, not about the quality of care for women...maternity care could suffer as trusts struggle to make efficiency saving and as the NHS itself struggles to cope with this profound shift in its structure.'

Professor Colin Talbot, from Manchester Business School, has queried whether the glaring lack of public accountability for the proposed GP consortia will lead to inefficiency or even worse:
"Now I am sure most GPs are good and honest folk with only the best interests of their patients and the taxpayers at heart. But some might not be, and the temptation could be very great indeed to cream off a little of that £80bn, could it not? Especially as it could almost certainly be justified as providing better local care for patients"

The Nuffield Trust has criticised the apparent lack of accountability that the reforms might create:
"Governance arrangements for GP consortiums, with respect to the accountability to the enrolled population served, are weak and need to be developed [because] the government has chosen not to mandate public involvement in the governance of GP consortiums".

Dr Kailash Chand OBE, Chair of Tameside and Glossop NHS echoed fears of privatisation:
"At the heart of Lansley's agenda may be the complete privatisation of the NHS – a process that has deep roots in Thatcherite ideology. We may be witnessing the end of the NHS as a publicly provided, publicly financed body."

It is ironic in the extreme that David Cameron, forever arguing that the government should trust 'front line' professionals, seems deaf to criticisms from almost all parts of the medical profession.

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