BMA warns against 'slash and burn' health reforms

Government health reforms are "potentially damaging" for patients and risk undermining the stability and long-term future of the NHS, medical leaders suggested today.

The British Medical Association (BMA) urged the Government to avoid taking a "slash and burn" approach to health care with "arbitrary" cuts and "poorly considered policies".

Warning the planned overhaul of the NHS could see focus shift from quality to cost, they questioned the value for money of reforms amid public spending cuts.

The proposals, set out in Health Secretary Andrew Lansley's White Paper, are designed to give GPs much of the multimillion-pound budget currently handled by primary care trusts (PCTs) and give hospital trusts greater independence.

But they have already sparked considerable debate, with critics suggesting the changes could destabilise the health service.

Dr Hamish Meldrum, chairman of council of the BMA, said: "There are proposals in the White Paper that doctors can support and want to work with. But there is also much that would be potentially damaging.

"The BMA has consistently argued that clinicians should have more autonomy to shape services for their patients, but pitting them against each other in a market-based system creates waste, bureaucracy and inefficiency.

"Doctors want to build on the founding principles of the NHS, and to maintain and improve services despite the hugely challenging financial climate. However, they can only succeed if they can work in partnership with others in a co-operative environment."

In a report released today, the BMA set out a series of concerns, concluding: "There are aspects of the White Paper's proposals which have the potential to undermine the stability and long-term future of the NHS."

Acknowledging the reforms had "positive elements", such as devolving more control to patients and frontline clinicians, it said these were threatened by plans for a market-based approach.

The report said: "The BMA has not supported the direction taken in the NHS in England in recent years, which is continued, and indeed accelerated, by the proposals set out in the White Paper, despite evidence showing that increased commercialisation has not been beneficial for the NHS or patients."

Insisting it remained "opposed" to the market approach, it continued: "Moreover, the wish, expressed frequently in the White Paper, to improve the patient experience and provide more seamless, integrated care, seems at odds with many of the policies which will, inevitably, widen the purchaser provider split."

Noting that "a large amount of money" would be spent on the proposals, it stated: "This is a very difficult climate in which to make substantial service changes and reconfigurations.

"We would question the value for money of such changes and whether a less disruptive, more cost-effective process could have been proposed to achieve similar aims of reducing bureaucracy and empowering clinicians."

It added: "We urge the Government and NHS organisations to focus on those areas where they can truly eliminate waste and achieve genuine efficiency savings rather than adopt a slash-and-burn approach to health care with arbitrary cuts and poorly considered policies."

And it warned that successful commissioning could only be achieved if other clinicians - such as hospital consultants - were brought into the process while management and administrative support would be needed by those taking on additional responsibilities.

Outlining its reaction to the White Paper, the BMA also expressed "serious concerns" about proposals for all trusts to have foundation status by 2013/14 and urged caution in "changing the ethos" of NHS provision.

But while it expressed support for the elimination of "unnecessary" bureaucracy and the reduction of top-down NHS targets, it concluded delegating "inappropriate" management tasks to clinicians would be "wasteful".

A survey of medical and nursing students revealed serious concerns about the reforms.

Some 45% of those polled feared the proposed restructuring would destabilise the NHS for years to come.

Only 18% of students felt the Government's proposed efficiency savings could be achieved without adversely affecting the quality of patient care.

However, 84% of students felt the NHS was too bureaucratic and 76% claimed it had too many managers.

Meanwhile, only 17% of those questioned felt replacing primary care trusts with GP-led commissioning consortia would improve patient care and 58% said GPs would end up spending more time on paperwork and less time on treatment.

Another 58% of students believed the Government would be unable to sustain real increases in NHS funding year-on-year over the course of this parliament.

Fergus Craig, commercial director at medical insurer AXA PPP healthcare, said: "Our survey demonstrates that medical students have real misgivings about whether this major overhaul of the NHS is the right approach to take right now.

"Health secretary Andrew Lansley will need to address those concerns if he is to keep our future doctors and nurses on side and in the UK."

More than 150 medical and nursing students were consulted for the Ipsos MORI poll between September 17 and 19.