Health secretary Andrew Lansley is being put under further pressure to agree to amendments to the Health and Social Care Bill designed to enact his ‘Liberating the NHS’ reforms.
Another royal medial college has voiced outright opposition to the bill, while the editors of three leading health journals have penned a joint editorial warning that even if it is passed the “bloated, opaque” piece of legislation will trigger further rounds of reform within five years.
The Royal College of Radiologists has joined the BMA, Royal College of Nursing and Royal College of Midwives in opposing the bill, saying it is worried it will unleash “unfettered competition” on the health service and increase health inequalities.
Meanwhile, the editors of the British Medical Journal, Health Service Journal and Nursing Times have said that Parliament should establish an independent, standing commission to lead a “mature and informed national discussion” on the future of the health service.
The editors warn that even if the bill is passed “we will still be in the dark about how much of the new system will work” but the result is likely to be an “unstable system that is only partially fit for purpose” and which is likely to need further reform within five years.
The ‘Liberating the NHS’ white paper was unveiled in July 2008, and the Health and Social Care Bill that is supposed to enact its core proposals has now been making its way through Parliament for a year.
The bill was ‘paused’ last summer when the government set up an NHS Future Forum to conduct a ‘listening exercise’ on its plans, which resulted in a number of changes.
However, senior members of the House of Lords, including Liberal Democrat Baroness Williams and Labour former health minister Lord Hunt, have threatened further amendments on key issues.
These include requiring the health secretary to continue to provide “a comprehensive health service for the people of England, free at the point of need”, as articulated in the bill that set up the NHS in 1948.
A number of newspapers reported over the weekend that Lansley was prepared to give ground on this point and on the amount of competition that will be permitted in the NHS.
But significant changes to the commissioning side of the reforms – which will see strategic health authorities replaced by outposts of the new NHS Commissioning Board, and many of the functions of primary care trusts passed to clinical commissioning groups – no longer seem practical.
Many of the changes are already being implemented on the ground, with staff working in SHAs and PCTs due to receive a letter saying what will happen to their jobs this week.
Even so, health academic Kieran Walshe has calculated that dropping the bill could save £1 billion in 2013, while leaving the NHS free to focus on its bigger job of meeting the ‘Nicholson challenge’ to save £20 billion over four years without big reductions in access and quality.
The Commons’ health select committee, which is led by another former health secretary, Stephen Dorrell, warned last week that the reforms were a “distraction” from the challenge.