MPs on public accounts committee hit out at free market model, saying there is 'no contingency to ensure services continue', writes Polly Curtis in the Guardian
MPs are demanding that the government urgently put in place plans to ensure vital health services continue if a hospital or other provider goes bust under its NHS reforms. In a report published on Wednesday, the public accounts committee says the proposals for the NHS do not include details of what will happen if providers fail in the new market model of healthcare provision.
Members of the committee dismissed claims by the most senior civil servant in the Department of Health, Una O'Brien, that the government was "not planning for failure", and condemned the lack of contingency planning, suggesting that the proposals now pose an intolerable risk to value for money and quality of services.
Richard Bacon, the Conservative MP for South Norfolk, said: "In any organisation as large and complex as the NHS, things can and do go wrong, and the Department of Health has yet to establish a robust framework for dealing with failure in the system. The department must not only understand the danger of either a provider or a commissioner going 'belly up', but also toughen up its contingency plans, drawing upon strong, effective and clear chains of governance and accountability throughout the new NHS model."
It is the latest in a series of critiques of the scale and pace of NHS reforms, after opposition from doctors, healthcare specialists and even the Liberal Democrats. The programme is currently on a two-month "pause" to allow the health secretary, Andrew Lansley, to conduct a "listening exercise". No 10 has ruled out any significant changes, but there is mounting speculation in Westminster that they could be preparing to reverse that position to avoid a clash over the NHS.
The report raises a series of other concerns about the reforms, including:
• That local commissioning could worsen current "postcode lotteries" in provision as different GP commissioning bodies veto different drugs or treatments.
• That there is no method for resolving disputes about who pays for treatment of the rarest conditions. All GP commissioners will pay a subscription into a "risk pool" to spread the cost of expensive and unusual treatments, but it's not clear what illnesses and eventualities this will cover, and the committee was told that GPs could unilaterally refer patients to it, raising the prospect that they will try to use the pot of money to suppress their own spending.
• That there is a risk – acknowledged in evidence from Sir David Nicholson, chief executive of the NHS – that the plans to find £20bn in efficiencies over the next three years to fund the rising budget for health will be harder to achieve amid a wide reform plan.
• That the devolving of decision-making to GPs and conversion of all hospital trusts to independent foundation trusts will weaken parliamentary accountability of the health system.
In evidence to the committee, O'Brien insisted that the NHS regulator, Monitor, would take over failing foundation trusts, but the MPs said this did not ensure continuity of services for patients. She confirmed that this could mean that private providers such as Bupa could face takeover by Monitor if they fail. But the committee said that this was not a detailed enough plan to protect vital services.
The MPs also raised concerns about struggling hospital trusts and how they would cope if they were given foundation trust status, highlighting the burden of costly PFI projects some face that could prevent them being able to operate on the cost base expected of others.
Hamish Meldrum, chairman of council at the British Medical Association, said he shared the PAC's concerns, adding: "'Market failures' in healthcare have far more serious consequences than in other industries, and may have little connection with quality of care, or even patient demand."
Lansley said that the government would consider the report during the two-month pause to listen to public opinion on the reforms. But he insisted that the reforms would result in a more efficient service. "We need to put in place a framework today, to safeguard the NHS for future generations tomorrow," he said.
In the Commons yesterday, before the publication of the report, shadow health minister Diane Abbott said Lansley was determined to "get away with as little substantive change" as he could to the health and social care bill, despite the launch of the listening exercise. Lansley said 119 events had been organised as part of the "pause" to "allow us to hear a full range of views, from professionals to public and patients".
Ms Abbott asked Lansley how he could "expect the public to take these discussions and the listening exercise seriously", adding: "Aren't they just a device to get the coalition through the May elections?" Lansley told her: "My objective, that of the prime minister, the deputy prime minister, all of the government, is further to strengthen the NHS. We will use this opportunity to ensure that the bill is right for that purpose."
Polly Curtis, the Guardian