by Daphne Liddle

MAJOR HEALTH unions last week lined up with MPs to express their alarm at the rapid pace of change being forced on the NHS at the same time that the service is being expected to find £20 billion in “efficiency savings”. They include Unison, Unite, the Royal College of Nursing, the British Medical Association and the Royal College of Surgeons.

The changes will see 150 primary care trusts abolished overnight and hand control over NHS funding to general practitioners — who are expected quite quickly to hand it on further to private sector management companies.

They will also introduce more competition between NHS hospitals and private sector establishments. In effect, it is the privatisation of the NHS more or less completed.

The House of Commons all-party select committee on health warned that the rapid total restructuring of the NHS is risky and expensive.

The need savings is already causing many non-life threatening operations and procedures to be banned in some areas and this is likely to increase.

The NHS confederation, backed by the BMA and the RCN, last week issued a strong warning that healthcare will suffer as a result of the changes.

John Black, president of the Royal College of Surgeons, last week told the Guardian: “The immediate need to save money by going for the soft targets of elective surgery would leave a lot of people with unpleasant symptoms and build up future health problems. Medically that makes no sense...


“This is a dangerous path for the NHS to be adopting, because of the long-term health problems that will inevitably be built up if operations designed to prevent long-term harm are delayed or stopped,” said Black.

“To restrict access will result in a lot more people having a lot more pain,” he added. “Patients who aren’t operated on won’t see their symptoms go away; they won’t magically get better. Their hip or knee will just degenerate.” Delay means an eventual operation is less likely to succeed, he said.

Similarly, men refused a hernia operation could end up developing a strangulated hernia, which requires emergency surgery; and if tonsils are left infected, infection can spread to the middle ear or brain, Black added.

Untreated gallstones can lead to complications that can reduce life expectancy. Cataracts untreated will leave people blind.

It all adds up to a lot more people needing sickness benefit for a lot longer.

The public sector union Unison warned the changes would cause “a perfect storm”. Karen Jennings, Unison head of health, said: “Health Secretary Lansley is just not listening to the crescendo of opposition. He is increasingly isolating himself from the views of the vast majority of patients, staff, health experts, charities, managers and politicians.

vanity project

“The planned overhaul of the NHS is Lansley’s vanity project. It will not benefit patients but will drain precious money away from the NHS and into the pockets of private health companies. The combination of these comprehensive changes, combined with the cuts will create a prefect storm that will shake the NHS to its core.

“These changes are not about modernisation, they are all about privatisation and creating a free market in the NHS — and they are irreversible. He must change course before it is too late.”

Dr Laurence Buckman, speaking for the BMA’s GPs’ committee, said: “Like the Health Committee the BMA believes that clinically-led commissioning has the potential to improve both the efficiency of the health service and the care provided to patients.

“However, we too are very concerned about the scale and pace of these reforms, coming as they do when the NHS also has to find up to £20 billion in efficiency savings. The speed of the reforms means Primary Care Trusts are imploding as staff leave in droves and those managers who are left are focussed on delivering the reforms rather than efficiency savings and the maintenance of patient care.

“We would not want to see the potential benefits of clinically-led commissioning lost, and that is a risk at the moment because key components of the Heath and Social Care Bill will make effective collaboration between doctors very difficult.

“We agree that for commissioning to really benefit patients it must involve all clinicians. Yet the government’s insistence on ratcheting up competition will make it harder for them to work together.

“GPs must be confident that if they choose to work with consultants from the local hospital because it enables integrated pathways to be developed, rather than a private sector organisation, it won’t be viewed as anti-competitive and therefore subject to a legal challenge.”