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NHS reforms face growing criticism

Shadow health secretary condemns 'bad deal' as BMA withdraws support

Shadow health secretary Andy Burnham has condemned the proposed changes to the NHS, published in the July White Paper Equity and excellence: Liberating the NHS, just days before the British Medical Association (BMA) published a new 34-page response, in which it called the reform proposals 'slash and burn' tactics.

Speaking to the Labour Party conference in Manchester on September 29, Burnham claimed the NHS was facing the biggest challenge in its 62-year history. He said that the White Paper came out of nowhere and contained "the wrong reforms at the wrong time — and a bad deal for patients."

Opposition from the Opposition
"My message today to the Prime Minister is simple: you can't pose as the friend of the NHS on one day and rip it to pieces the next. People will not forgive you for it," Burnham continued.

"You have no mandate for the break-up of a successful NHS. Patients aren't asking for it. GPs and NHS staff don't want it. The public did not vote for it. I say to you today — put these dangerous plans on hold. Give the NHS the stability it needs. If you don't, get ready for the fight of your life — and the public will be on our side, not yours."

Burnham has been vocal in his opposition to the proposed reforms since the publication of the White Paper. Speaking in July, the shadow health secretary called the reforms 'a reckless gamble' and an unwarranted ideological experiment, saying that the £3bn to be spent on the reorganisation would be better spent on essential care services.

"Andy Burnham's speech [to the Labour Party conference] is without any vision or hope for the NHS; unsurprising, given he doesn't support the coalition's commitment to health spending," an aide to health secretary Andrew Lansley was quoted as saying on the BBC website. "The coalition will not make the sick pay for the deficit we inherited from Labour and we will not squander the money as Labour did. Instead, we will use this opportunity to sustain and improve care for NHS patients."

Opposition from HCPs
However, Burnham's claims that healthcare professionals (HCP) don't want the reforms was borne out by a letter to the Times, which was written by a group of GPs and published the same day Burnham made his speech.

The letter, entitled 'Does the NHS really need yet more reform?' warned that the vast majority of doctors lacked the skills or experience to take on the responsibilities currently held by primary care trusts (PCT).

'Moreover,' it stated, 'these plans, untried and untested as they are, expose the NHS to an unacceptably high level of financial and clinical risk.'

Opposition from the BMA
In its latest statement on the reforms, the BMA is apparently in agreement with the GPs' letter.

Indeed, Dr Richard Vautrey, deputy chair of the BMA's GP Committee, said that the majority of family doctors had 'concerns'.

In its response document, published October 1, the association claimed that, though it was not against the reforms in principle, it nevertheless had 'fundamental concerns', principally regarding the rate of change set out for the reforms, which it claims could impact the ability of the NHS to make the required £15-20bn savings by 2014. The biggest criticism surrounded the move towards the more 'market-based approach' outlined in the White Paper.

In its executive summary of the new response, the BMA wrote that: "There are elements we broadly support, elements we support in part, elements we are unable to support and elements about which we require more detail before we can develop a fully considered position."

This is in contrast to the statement the BMA originally published in support of the White Paper this summer, when it said it was 'ready, willing and able' to implement the changes. It now claims the proposed reforms could have grave implications for the 'stability and long-term future' of the NHS.

"We urge the Government and NHS organisations to focus on those areas where they can truly eliminate waste and achieve genuine efficiency savings rather than adopt a slash-and-burn approach to health care with arbitrary cuts and poorly considered policies. Robust evidence must be gathered and proper processes put in place, and we welcome the commitment to actively involve clinicians, patients and local populations in decision-making processes," said the BMA document.

Instead of the changes as currently proposed, the BMA has urged for PCTs to be maintained while simultaneously increasing GP commissioning powers, saying that this would be the more cost-effective option.

While the BMA does not support the direction the NHS has taken in recent years, making the changes suggested in the White Paper to the existing timetable, could cause the NHS to 'implode' according to the BMA response.

Bureaucracy cuts
Ahead of the proposed dramatic reductions in NHS management costs, PCT chief executives are leaving although, according to director of the primary care trust network at the NHS Confederation David Stout (quoted in the Financial Times), it is difficult to judge whether the pace of staff turnover is increasing in light of the White Paper's publication. The BMA has expressed grave concerns over whether it will be possible to establish GP-led commissioning before PCTs are phased out completely and the best NHS managers are lured away to jobs with more long-term security.

Shortly after the White Paper was published, early poll results among GPs showed that 51 per cent supported the commissioning plans, with just 31 per cent in opposition. A new poll conducted recently by Pulse has shown that now 38 per cent of doctors support the changes, with 48 per cent in opposition.

The consultation period for the White Paper closes on October 11.

Related links

White Paper: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117353

Text of Andy Burnham's speech to the Labour Party Conference:
http://www2.labour.org.uk/andy-burnhams-speech-to-labour-party-conference,2010-09-29

BMA response: http://www.bma.org.uk/healthcare_policy/nhs_white_paper/index.jsp

1st October 2010

From: Healthcare

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