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Bill ‘spells the end of the NHS’

Proposed reforms will lead to end of genuinely national health service

Louise Prime

Friday, 28 January 2011

The Health and Social Care Bill as it now stands spells the end of the NHS as we know it, Editors have declared in The Lancet. The authors of today’s lead Editorial say that handing commissioning over to GPs – whose strength, they say, is assessing clinical need rather than concentrating on cost – means that the philosophy of a genuinely national health service will be replaced by  the ethos of the individual providers.

They argue that the coalition Government’s proposed reforms are similar in some respects to the Conservative Government’s ‘fundholding experiment’ in the 1990s – which, they say, took years to implement and produced little evidence of short- or long-term benefits.

They add: “In the current Bill, health outcomes, including prevention of premature death, will be the responsibility of the NHS Commissioning Board, which has been asked to publish a business plan and annual reports on progress. That business plan is urgently needed to allow transparent appraisal of how the Board plans to monitor patients’ outcomes.”

The authors also strongly criticise both the Conservative and the Liberal Democrat parties for trying to bring in substantial changes that were not mentioned in their general election manifestos. They remind doctors of the Conservatives’ promise to scrap “politically motivated targets that have no clinical justification” and of what they call their ‘particularly hollow’ claim to be “the party of the NHS”.

The Editors quote a 1948 Lancet Editorial welcoming the formation of the NHS, which said: “Now that everyone is entitled to full medical care, the doctor can provide that care without thinking of his own profit or his patient’s loss, and can allocate his efforts more according to medical priority. The money barrier has of course protected him against people who do not really require help, but it has also separated him from people who really do.”

The writers of this week’s Editorial argue: “Now, GPs will return to the market place and will decide what care they can afford to provide for their patients, and who will be the provider ... The ethos will become that of the individual providers, and will differ accordingly throughout England, replacing the philosophy of a genuinely national health service.”

They conclude: “Health professionals cannot say that no change is needed – it most certainly is. But there is sufficient uncertainty and concern about the changes outlined in the Health and Social Care Bill to pause, to learn from the past, and to consider what the changes mean for patients’ outcomes.

“As it stands, the UK Government’s new Bill spells the end of the NHS.”

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