NHS cuts attacked by leading medical journals

Andrew Lansley’s plans for the NHS were attacked today by both Britain’s leading medical journals as the Government admitted £1.7bn had been set aside to fund the changes in the first year.

The Lancet and the BMJ published separate editorials criticising cuts in NHS funding and proposals, set out in a white paper “Liberating the NHS” this week, to pass control of the bulk of the NHS’s £105bn budget for England to consortia of GPs.

Kieran Walshe, professor of health policy at Manchester Business School says the reorganisation is likely to cost up to £3bn to implement with no guarantee that it will improve performance or lead to better care for patients.

None of the different structures put in place over the last 20 years had been better or worse than others, the transition costs were huge and reorganisations had adversely affected performance in the past.

“It is a huge distraction from the real mission of the NHS - delivering healthcare and improving quality - and can absorb a massive amount of managerial and clinical time and effort,” he writes.

In The Lancet, an unsigned editorial demands that Mr Lansley “tell the truth about NHS cuts” which it claims are happening to front line services in contravention of the Conservatives’ pledge to protect them.

It cites a document obtained from Oxfordhsire and Buckinghamshire Mental Health NHS Foundation Trust, dated June 2010, which identifies savings of £5.3m to be achieved on its budget of £42m, a 12.6 per cent cut over the next four years. Three of 19 consultant psychiatrists, 16 care coordinators and nine other workers are to go. It says the cuts may lead to a “reduction in quality of service”, “patients and carer disatisfaction”, and “poorer service response”.

Cuts of 14 per cent are faced by many medical schools over the next three years, the Lancet says. “The only way these cuts will be realised is through loss of front line staff.”

Earlier, Richard Horton, editor, questioned whether GPs would be able to cope with the new responsibilities thrust upon them. He said the forerunner of the plans - GP fundholding introduced by the previous Conservative government in the 1990s - had never been properly evaluated, research suggested it had “serious flaws”, and the complexity of contracting was “hugely underestimated.”

Professor Steve Field, chairman of the Royal College of GPs dismissed the criticisms. “The fundamental change is that family doctors, working with specialists and nurses, should lead the commissioning groups. Change can be disruptive but sometimes you need disruption to effect change. Once we get the detail and it is communicated with GPs I think they will understand that this is a real chance. The big challenge is to get GPs working together and managers supporting them.”

Mark Porter, chair of the consultants committee of the British Medical Association, said Professor Walshe’s analysis was “exactly right”.

“We are coming into a period of tight resources and we are unsure how to seek quality in the NHS. So the Government says let’s reorganise things and hope they turn out well. That is so depressing as a message.”

But he added there was a “glimmer of hope” in the plan to empower clinicians and make GPs responsible for purchasing services for their patients.