NHS shake-up: Pressure building after critical report

Doctor The health bill is working its way through Parliament

Pressure is building on ministers over the NHS reforms in England after a critical report by MPs has added to the mounting concerns.

The health select committee report said the overhaul was hindering the ability of the NHS to make the savings it needs to safeguard its future.

It comes ahead of a meeting this week of medical leaders about the plans.

Health Secretary Andrew Lansley has again defended the reforms, saying they were "essential" for improving the NHS.

The report by MPs, which was leaked over the weekend, did not specifically look at the changes.

Instead, it was focused on how the health service was doing in meeting its savings target.

While the health budget is being protected, it has still been told to save £20bn by 2015 through improving productivity to keep pace with the rising demands linked to the ageing population and lifestyle factors, such as obesity.

'Disruption and distraction'

The MPs said there were strong concerns about the ability of the NHS to make the savings - the equivalent of 4% a year.

It said there had been too much emphasis so far on short-term cuts and "salami-slicing", instead of rethinking the way care is delivered.

And it argued there needed to be more integration with social care to stop people needing hospital treatment, which tends to be more expensive.

But it warned that in some ways the opposite was happening as councils were increasingly restricting access to services.

On the reforms, it concluded they were "complicating" the savings process because they were acting as a "disruption and distraction".

The committee is chaired by Conservative former health secretary Stephen Dorrell, who said every comment about the NHS tended at the moment to be framed by the debate about the bill.

Analysis

There is a growing sense that the critics of the NHS reforms are scenting blood.

Last year's pause had taken the sting out of the attacks and the bill was well on its way through Parliament when 2011 came to a close.

But there is now a feeling among those who have been expressing concerns about the changes that the momentum is again gathering behind them.

The decision last week by the midwives and nurses to move to "outright opposition" attracted attention - as has this report by MPs.

Ministers accused the unions of being motivated by the row over pensions.

But later this week a host of health bodies are meeting to discuss the reforms.

The majority of them are professional bodies that are focused on standards. So if they come out with a strong rejection of the plans it will get even more difficult for ministers.

Attention will then turn to the Lib Dems and whether their MPs will block the bill when it returns to the Commons.

There are no signs of that happening at the moment, but serious questions will start to be asked.

He said the need to achieve efficiency savings in the NHS was paramount, and that the bill must come second.

"The priority is to deliver more efficient care, in order to meet demands placed upon the system - and the implementation of the bill has to fit in around that," he said.

The findings have prompted critics to renew their attacks.

Last week the Royal College of Midwives and Royal College of Nursing said the bill underpinning the changes should be scrapped - joining the British Medical Association in moving to outright opposition.

Rachael Maskell, of the Unite union, said the report should be the "final nail in the coffin" for the bill.

And BMA chairman Dr Hamish Meldrum said the plans will prove harmful to patients.

"The health select committee say it's distracting - we would say it's completely unnecessary and somewhat dangerous.

"As the Health Select Committee say, it's taking everybody's mind off the real issues, which is trying to run an efficient health service, trying to make changes to the health service for the benefit of patients, and, at the same time, trying to identify savings."

Peter Carter, general secretary of the Royal College of Nursing, said the plans will pose a threat to patient safety and the future of the NHS itself.

"We completely concur that money has to be saved. We've never disputed that, it's the way they're going about it."

'Uncertainty'

Concerns were also expressed outside of the union movement.

Professor John Appleby, chief economist of the King's Fund think tank, said: "The report should serve as a wake-up call for ministers and the NHS about the magnitude of the task ahead."

And Mike Farrar, of the NHS Confederation, which represents NHS managers, agreed.

He said there was a lot of "uncertainty" in the NHS at the moment that was dangerous.

Start Quote

The legislation's not completed its passage, the Lords are making many significant and constructive suggestions, and we will take those on-board, but the principles of the bill are widely supported”

End Quote Andrew Lansley Health Secretary

"The NHS faces a once-in-a-generation financial challenge that is still to be explained properly to the public," he added.

Attention will now turn to the meeting on Thursday when the Academy of Medical Royal Colleges, an umbrella group of 20 organisations, and unions will discuss what to do about the plans.

The bill is still working its way through Parliament and at the weekend Deputy Prime Minister Nick Clegg said the planned reforms must go ahead, despite the fresh criticism from MPs.

A number of major structural changes have already taken place within the health service and senior staff have started to be recruited to head up the new organisations.

Enough GPs have also come forward to set up the new management groups to cover 97% of the country.

Mr Lansley said the government's plans for modernisation were "essential if we are to put the NHS on a sustainable footing for the future".

He told the BBC: "We have to deliver more care in the right place at the right time. That means more care in the community.

"There's been support for the principles of what we're doing, including from many of the leading professional organisations.

"The legislation's not completed its passage, the Lords are making many significant and constructive suggestions, and we will take those on-board, but the principles of the bill are widely supported."

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