Sweeping NHS reform must not be 'rushed through' in pandemic, warns BMA

BMA leaders have hit out at plans for 'sweeping reorganisation' of the NHS set out by the government as the health service struggles with the COVID-19 pandemic.

BMA chair Dr Chaand Nagpaul (Photo: JH Lancy)
BMA chair Dr Chaand Nagpaul (Photo: JH Lancy)

The government is setting out a white paper that will reverse parts of the 2012 Health and Social Care Act introduced by former health secretary Andrew Lansley.

Powers transferred to NHS England from the DHSC in 2012 will be clawed back to ensure the health and social care secretary has 'the right levers to ensure accountability back to parliament and taxpayers', the government has said - although it has insisted the 'clinical and day-to-day operational independence of the NHS' will be maintained.

The changes will bring the NHS and local government together legally in integrated care systems, and will scrap 'unnecessary tendering processes for healthcare services'.

NHS reform plans

It will upgrade the Healthcare Safety Investigations Branch to a statutory body, and include reforms to social care and public health.

However, doctors' leaders have raised serious concerns about the changes and their timing.

BMA chair Dr Chaand Nagpaul said: 'While the BMA supports greater collaboration within the NHS, our members and their colleagues need a real chance to assess these plans and their implications. On the back of a year in which doctors have gone above and beyond in responding to the greatest health crisis in a generation, they are now both physically and emotionally exhausted.

'Proposals for sweeping reorganisation on such a scale will need greater time for consideration and must not be rushed through while doctors are still tackling the winter surge in infections, hospitalisations and tragically, deaths.

COVID-19 backlog

'The immediate and forthcoming challenge for the NHS will be addressing the greatest backlog of care our health service has ever faced, alongside the continued pressures of COVID-19. This requires significant new resources and an immediate action plan, rather than risk being diverted by a reorganisation of the health service in the midst of the pandemic.'

Dr Nagpaul said the BMA had long campaigned against 'wasteful and bureaucratic NHS procurement rules that require all contracts to be put out to competitive tender' - but warned that proposals in the white paper 'could lead to awarding contracts without sufficient scrutiny to outsourced providers at huge expense to the taxpayer'.

He added: 'We have seen the devastating impact of this happening during the pandemic with both PPE and "NHS" Test and Trace.

Richard Murray, chief executive of the King's Fund think tank said the 'government and national NHS leaders should be looking to step away from the damaging model of top-down command and control in the NHS'.

NHS England powers

He said the 'independence given to NHS England is seen as one of the successes of past reforms' - but that ministers now clearly 'intend to take greater control of national decisions about the NHS'.

He warned: 'There is much to welcome in the ambition of the white paper, but the history of the NHS is littered with reform plans that overestimated benefits and underestimated disruption. These latest proposals add up to a major reform package and come at a time when the NHS, local authorities and charities are still battling COVID-19.

Health and social care secretary Matt Hancock said: 'The NHS and local government have long been calling for better integration and less burdensome bureaucracy, and this virus has made clear the time for change is now.

'These changes will allow us to build back better and bottle the innovation and ingenuity of our brilliant staff during the pandemic, where progress was made despite the legal framework, rather than because of it.'

NHS chief executive Sir Simon Stevens said: 'Our legislative proposals go with the grain of what patients and staff across the health service all want to see – more joined-up care, less legal bureaucracy and a sharper focus on prevention, inequality and social care.

'This legislation builds on the past seven years of practical experience and experimentation across the health service and the flexible "can-do" spirit NHS staff have shown in spades throughout the pandemic.

'The proposals are designed to be flexible, allowing the health and care system to continue to evolve, and are designed to better equip the NHS and local health services to meet the longer-term health and societal challenges over the coming decades.'

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