Protect clinicians’ say over local health service changes

Health organisations have warned that government reforms that are set to hand ministers largely unchecked new powers over local health service decisions risk undermining public confidence in the NHS.

A coalition of health organisations have joined forces to call for ‘checks and balances’ on proposed new powers for the Secretary of State for Health and Social Care which would enable them to intervene at any stage of a decision about changes to local service, such as changing the location or the type of treatment provided by an NHS organisation.

There are increasing fears that ministers in Whitehall could end up making decisions about local GP and dentistry services without having to disclose the basis of their decision to patients and the public. This is despite there already being a well-established process in place for consulting on changes to local services.

The NHS Confederation, Local Government Association and the Centre for Governance and Scrutiny have recommended an amendment to the Health and Care Bill which is being considered by Parliament. This would require the ministers to consider clinical advice from senior local doctors and justify publicly why the decision made was in the public interest. The proposal also has support from the British Medical Association and National Voices.

Matthew Taylor, chief executive of the NHS Confederation, said: “There is widespread support for most aspects of the government’s NHS reforms, which have been largely driven from the bottom-up by NHS leaders to enable more co-ordinated care for patients. There is consensus among NHS leaders that this will not result in ‘privatisation’ of the NHS.

“But one area where there is real concern is over the proposal to extend ministerial control over changes to local services. The NHS costs £150 billion a year so accountability to Parliament is vital. But the risk is we end up with more politically motivated decisions which erode the NHS’ clinical and operational independence. We already have one of the most centralised healthcare systems in the world and if these reforms are to work then we must resist further centralisation of power in Whitehall.

“Ideally, these powers would be removed. But, at minimum, there needs to be public transparency on the decisions that are made by the secretary of state and the evidence base upon which they are made. In our view this must include a requirement for the secretary of state to have regard to, and publish, the clinical case offered by the Integrated Care Board in relation to any decision. Ultimately, any ministerial intervention in local service changes must be fully transparent if public confidence is to be maintained.”