NHS White Paper Reforms
I would like to put to you a way forward on NHS reforms, in light of the fierce criticism that is emerging from professional bodies.
As you know, we support giving doctors more say over decisions in the health service. That was the thrust of the Next Stage Review, conducted by Ara Darzi. However, we have grave reservations about your plans to do this, and our warnings have today been endorsed by the BMA.
On Wednesday, in my speech to the Labour Party Conference, I asked the Prime Minister to put these plans on hold, give the NHS the stability it needs to face up to the financial challenge, or get ready for the fight of his life.
Your plans are completely unacceptable to us and, if you proceed on the timetable you have set out, we will launch a major campaign in every community.
However, if you are prepared to listen, we will step back from that and engage constructively in the debate over the future of the NHS.
The BMA have today said:
“Taken together, the proposed reforms risk undermining the stability and long-term future of the NHS.”
All of us who care about the NHS must agree that such a risk is too great.
I strongly back the sentiment of the BMA, and the group of GPs who wrote to the Editor of The Times on Wednesday, that a “less disruptive, more cost-effective process” could achieve the aim of clinical empowerment.
I would therefore like to make three constructive suggestions that I believe would allow you to pursue your objectives, but avoid exposing the NHS to intolerable levels of risk:
1. Make the White Paper a Green Paper
This would bring the reforms into line with usual Government protocol. It would allow for further engagement and development on a range of policy proposals, with a subsequent White Paper setting out the Government’s clear policy intentions. A Bill would follow, with significant time put aside for pre-legislative scrutiny.
I therefore ask you to delay bringing any legislation affecting the future of the health service before Parliament by at least a year.
2. Maintain PCTs in their current form for the medium term
Today the BMA have warned about the ‘implosion’ of PCTs. This is simply too great a risk to the public. I believe the lack of a population-wide commissioning body is a major flaw in your plans, and I would argue for the retention of PCTs or a similar statutory body in the NHS.
While we debate that issue, I would ask you to signal that PCTs are secure in the medium term. This would give the NHS the organisational stability it needs over the next few years to meet the unprecedented productivity and efficiency challenge.
3. Pilot GP commissioning
With the current organisational structure in place, GP commissioning could be piloted in a limited number of areas. This would allow the model to be tested for applicability in a range of settings, and for evidence to be gathered to make the argument for national roll-out.
This pilot process would help test the concerns of groups representing those with rare and complex needs that the proposals would reduce equity in the system and fail to support those who need long-term, integrated care.
It would enable us to debate a major hole in your plans – the arrangements for specialised commissioning. I find it staggering that you have published a White Paper that does not adequately address this critical area of the NHS.
I believe these are measured and reasonable requests that will be supported by many in the NHS, and could help to calm fears over these reforms.
I hope you will agree that in light of growing opposition to the timing, pace, scale and cost of the proposed reforms, these steps would be in the best interests of the NHS.
You have an opportunity at your conference next week to signal the way forward from here. I very much hope that you will consider these suggestions and that we are able to avoid a divisive and damaging period for the NHS.
But if you proceed as planned, we will fight you every single step of the way, because, in the words of the BMA, your plans present a ‘risk to the long-term future of the NHS.’
RT HON ANDY BURNHAM MP
Shadow Secretary of State For Health