Ministers seek to answer critics as NHS bill published

Cameron and Miliband in Commons clashes over NHS changes

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Ministers have hit back at critics as they unveiled legislation seeking to shake-up the NHS in England, saying change is a "necessity not an option".

The Health and Social Care Bill will allow GPs to get control of most of the NHS budget from 2013.

Ahead of its publication, unions had warned it could undermine the NHS.

But Health Secretary Andrew Lansley spelt out how essential services would be protected and GPs supported, saying it was not as radical as claimed.

Speaking after the bill was laid in Parliament, Mr Lansley accepted there were "new and distinctive" elements but said it was more about evolution as it built on many of the changes introduced by Labour.

Competition

Choice, use of the private sector and setting hospitals free as foundation trusts were all started under the previous government.

He said unions were always "against competition", but they were wrong in saying it would lead to the destruction of the health service.

He said: "Modernising the NHS is a necessity, not an option, in order to meet rising need in the future we need to make changes."

GP view: How patients may benefit

Dr Ken Aswani, a GP in Waltham Forest, on the outskirts of London, is at the forefront of the changes. He is the lead doctor in one of the consortia which is piloting the changes for the government.

"We will be looking to build on what we have been doing in recent years. That means getting services out of hospital and into the community where they are more accessible."

One example of this that is already up and running is in dermatology care. There are now three clinics linked to GP centres across the borough where nurses, specially-trained GPs and hospital consultants work together to see people with skin problems.

Dr Aswani says: "It is much quicker now and patients do not have to travel as far."

Under the plans, GPs working in consortia will take on responsibility for "buying in" the bulk of hospital and community services for their patients.

In the process, all 151 primary care trusts (PCTS) and strategic health authorities will be disbanded.

In the lead up to the bill's publication, fears were voiced that hospitals could go bust as the plans include opening up the NHS to "any willing provider".

Critics have also questioned whether GPs have the experience and skills to handle such huge budgets - they will have control of about 80% of the NHS budget.

The timing has also been questioned, as the health service is being asked to save money in coming years.

Start Quote

This Titanic health bill threatens to sink our NHS”

End Quote Karen Jennings Unison

But in setting out the details of the bill, Mr Lansley said the national independent board would support GP consortia as they were established.

He also said while trusts could go under regulators would be able to step in to ensure "essential" services continued.

Savings

And documents released alongside the bill claimed the changes would save money.

While the overhaul will cost £1.4bn, this would be paid for through savings within two years, the paper suggested.

By 2015, £5bn could be saved through cutting the number of people working in management and administration.

Earlier, during exchanges at prime minister's questions, David Cameron was accused of being "arrogant" for going ahead with the moves despite warnings from unions and health experts.

Labour leader Ed Miliband said medical staff had warned of "potentially disastrous" consequences for the health service.

But the prime minister said the government was "reforming the NHS so that we have got the best in Europe".

The changes were first set out in a white paper published last summer. They apply solely to England - Scotland, Wales and Northern Ireland have different systems.

GP view: How patients could suffer

Dr Helena McKeown, a GP based in Wiltshire, describes herself as a sceptic. She believes one danger is that consortia may decide that some of the more marginal services are not a priority for funding.

She also fears local hospitals could be hit as private sector providers look to win more NHS contracts. She gives the example of ophthalmology departments which rely on cataract operations for income.

"Private firms will want the cataracts as they are less risky and less complex, but the consequence of that is the local hospital department could suffer.

"This could happen all across the hospital. I see it as like that game Jenga - if you pull too many blocks out the whole thing topples down."

But despite Mr Lansley's attempts to answer the critics, health staff and independent experts still said they were worried.

Karen Jennings, head of health at Unison, said: "This Titanic health bill threatens to sink our NHS. The only survivors will be the private health companies that are circling like sharks, waiting to move in and make a killing."

Professor Chris Ham, chief executive of the King's Fund health think-tank, was more measured.

He said getting GPs more involved was a good move, but warned the changes were at risk from "the combination of the funding squeeze and the speed and scale of the reforms".

Shadow health secretary John Healey said: "It's a huge upheaval which will put unnecessary extra pressure on the NHS and could open up all parts of the NHS to competition from private health companies."

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