More NHS reform in five years 'guaranteed' if Bill goes through, say editors - Telegraph.co.uk

The intervention of three supposedly objective editors - Dr Fiona Godlee at the BMJ, Alistair McLellan at the HSJ, and Jenni Middleton at the Nursing Times - perhaps makes that particular argument a little weaker.

They say the Bill has already "destablised the damaged one of this country's greatest achievements", but predict that despite being a "bloated and opaque piece of legislation" it is still likely to receive Royal Assent.

Mr Lansley believes it will reform the NHS by putting patients first and by enabling doctors and nurses to control how it runs, rather than bureaucrats. However, the editors think it will leave the service in chaos.

They write in the BMJ: "For it to work, the system will have to rely on a set of complex and sometimes conflicting relations between the Department of Health, the Commissioning Board, clinical commissioning groups, as yet undetermined clinical commissioning services, local authority health and wellbeing boards, and a host of other national, regional, and local actors."

They conclude: "Because the proposed new system will struggle for resilience or cohesion, the next government will find it necessary to overhaul the NHS again. This is not good for anyone, least of all the front line staff.

"But ironically this may be Lansley's one great achievement: reforms designed and implemented so badly that another major NHS reform programme is guaranteed within five years."

The trio think parliament should establish an independent commission "to initiate a mature and informed national discussion on the future of our national health system".

In a separate piece in the BMJ, Kieran Walshe, professor of health policy at Manchester Business School, calculates that scrapping the Bill would save "just over £1 billion in 2013."

Andy Burnham, the Shadow Health Sectretary, commented: "The crisis of professional confidence in Andrew Lansley and his Health Bill is deepening. By dropping the Bill, the Government would bring much-needed stability, save over £1 billionnext year and allow the NHS to focus on the financial challenge."

Not all are opposed to the Bill. The NHS Confederation, which represents health authorities, has a policy of critical engagement - even though the bill will result in half its members being abolished.

Those heading the 'clinical commissioning groups' that will take over from local health authorities are also broadly in favour, as demonstrated by a letter from 56 of them to The Daily Telegraph last Saturday.

Mr Lansley himself appears confident the Bill will pass into law, telling a Sunday paper that unlike his predecessors who had attempted reform, "I'm in a position where my party support me, my prime minister supports me".

Much opposition is focused on what critics say is the Bill's main objective - increasing competition in the NHS by opening it up to private providers.

On that issue, it received a boost today from the Office of Health Economics, a consultancy.

It publishes a report finding that "quality based competition with prices fixed by a regulator can be beneficial" to the NHS, by "producing higher quality care at the same cost on average and, importantly, not leading to increased inequity in access to health care".

A Department of Health spokesman said: "Our reforms are based on what NHS staff themselves have consistently said - they want more freedom from day to day bureaucracy and political interference so they can get on with the job of caring for patients. That is exactly what this Bill achieves.

"Through the independent NHS Future Forum we have already had hundreds of meetings, discussions and public debates with thousands of people on the future of the health service. To start this process again would undermine the development of clinical commissioning and prevent healthcare professionals taking decisions in the interests of their patients."

She added: "It's completely untrue to suggest that dropping the Bill would save the NHS money. Our plans will reduce needless bureaucracy by a third and save £4.5 billion over the course of this Parliament and £1.5 billion every year afterwards. Every penny saved will be reinvested in frontline care for patients."