NHS reforms ‘are destabilising'

London: The senior doctor called in by David Cameron to review the government's health reforms has dismissed them as unworkable and "destabilising" in provisional conclusions that could fatally undermine the plans.

Prof Steve Field, chairman of the NHS Future Forum - set up last month to undertake the coalition's "listening exercise" - flatly rejects the health secretary's plan to compel hospitals to compete for patients and income, which he says could "destroy key services".

The proposal, contained in Andrew Lansley's health and social care bill, has led key medical organisations to warn that it will lead to the break-up of the NHS and betray the service's founding principles.

In an interview with the Guardian, Field says Lansley's plan to make the NHS regulator Monitor's primary duty to enforce competition between health care providers should be scrapped. Instead it should be obliged to do the opposite, by promoting co-operation and collaboration and the integration of health services.

Dangers of free market

"If you had a free market, that would destroy essential services in very big hospitals but also might destroy the services that need to be provided in small hospitals," says Field.

"The risk in going forward [with the bill] as it is, is [of] destabilising the NHS at a local level. It would lead to some hospitals not being able to continue as they are. If you were to say ‘we're going to go out to competition for vascular surgery services', University Hospital Birmingham wouldn't be able to run their own trauma centre, for example, because you wouldn't have the staff and the skills on site to do things and the volume of procedures needed to ensure clinical standards remain high."

UHB is one of England's best-regarded hospitals and its trauma service, which treats injured military personnel from Afghanistan and Iraq, is widely admired.

"We need some significant changes in how the role of Monitor is described and enacted in order to reassure patients and doctors and nurses", Field says.

The prime minister has become concerned that the bill's promotion of competition has allowed its many critics to claim that the health service will be privatised.

In a series of policy suggestions that will help Cameron deliver the "significant and substantial" changes to the bill he promised this week, Field suggests that there should be agreed lists of "designated" protected core services that each hospital in England had to provide to ensure the NHS remained a truly national service. For example, each smaller hospital should have to have an AE and maternity unit, unless there was another close by, he said. Smaller hospitals could be given subsidies to ensure their long-term future.

Field's group of 44 health experts will deliver its final report to Cameron, Nick Clegg and Lansley at the end of the month.

In remarks that will be closely studied in Downing Street, Field also suggests:

All the new GP consortiums should have a reserved place on the board for a nurse and a representative of local doctors, to reduce the alienation felt among health professionals.

A series of new "clinical cabinets" should be set up containing local health, social care and council representatives. They would advise consortiums, NHS hospitals and public health departments.

Networks

GPs do not have the skills to commission several key sorts of health care "including maternity services and end-of-life care", so in those areas will need to do so in new "networks" groups of consortiums, overseen by the NHS National Commissioning Board.

However, while Field rejects the most controversial element of the Lansley plans, he also risks angering medical groups by suggesting that competition should still be increased in the NHS to drive up standards and give patients more choice. The limit on what semi-independent foundation trust hospitals can earn should be lifted and would benefit rather than endanger the NHS, he says.

— Guardian News & Media Limited