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Health and Social Care Bill continues to cause chaos in the NHS, says BMA (added 7/12/11)

Chaotic and poorly co-ordinated structural change currently taking place throughout the NHS in England before the Health and Social Care Bill is even law continues to threaten service stability, the BMA said today (Wednesday 7 December 2011), in its latest briefing for peers currently debating the legislation1.

At its November meeting, BMA Council voted to change its position to outright opposition to the Bill in its entirety2. The briefing paper sets out why doctors have hardened their position on the Bill in the context of the wider NHS reform agenda.

Commenting, Dr Hamish Meldrum, Chairman of BMA Council, said:

“There has been a growing level of unease about how the reforms are panning out – we hear repeated concerns from doctors about mounting chaos on the ground. For example, Clinical Commissioning Groups (CCGs), that had initially been told they’d have freedom to form to suit their local communities, are now being told they’re too small and have to re-form. People are still unclear how primary care will be managed as we don’t yet know where staff currently working in Primary Care Trust ‘clusters’ will eventually be based or if they’ll have jobs at all. Even at this stage, there are still unanswered questions about what statutory functions some bodies will have, making planning very difficult.

“Guidance is being issued that is overly restrictive and more and more bureaucracy is being created to try to deal with issues which should have been dealt with at the beginning. A huge amount of time, energy, money and commitment has been wasted because of a lack of a clear plan from the outset.”

The BMA’s main concerns with the current approach include:

An overambitious timetable: although the legislation has not yet been agreed, changes are already taking place both nationally and locally and assumptions are having to be made about the final architecture. The end result has been chaos on the ground.
Complexity: the stated aim of reducing bureaucracy now looks meaningless as new bodies and structures are being created, all with complex interrelationships.
Knock-on effects: much greater thought needs to be given to how the knock-on effects from the structural changes in the Bill will impact on other strands in the Government’s wider NHS reform plans.
Rhetoric not matching the reality: the Government has said it wants to empower clinicians to commission on behalf of patients, however many of the powers of the NHS Commissioning Board set out in the Bill seem overly restrictive.

Dr Meldrum added:

“We want the Government to rethink its reform package and withdraw the Bill. It should be focusing on delivering high-quality, coordinated and integrated health care, not side-tracking staff with major structural reform. Continuing with this legislation, especially in a period of huge financial constraint, is an enormous risk.”