Nearly 400 public health experts warn Lords to reject NHS reforms

In an open letter to peers published in The Daily Telegraph, the public health specialists say that Health Secretary’s proposals will put patient safety at risk, waste money and damage trust in the medical profession.

They say that the Health and Social Care Bill, which aims to give more power and choice to GPs and patients by reducing management and opening up more services to private companies and the voluntary sector, will weaken the ability of the authorities to fight disease and tackle health emergencies.

The experts also tell the Lords that the Health Secretary, who will address the Conservative Party Conference on Tuesday afternoon, is wrong to claim that doctors support him.

They conclude: “It is our professional judgement that the Health and Social Care Bill will erode the NHS’s ethical and co-operative foundations and that it will not deliver efficiency, quality, fairness or choice.

“We therefore request that you reject passage of the Health and Social Care Bill.”

Their intervention will dismay ministers, who had hoped that opponents of the NHS reforms had been won over by the watering down of the proposals in an unprecedented “listening exercise” before the summer.

Nick Clegg, who forced the “pause” in the Bill’s progress after a uprising by grassroots Liberal Democrats in the spring, stopped his party calling for more substantial changes at this month’s conference.

But the public health specialists behind today’s letter are still hopeful that the legislation could be rejected at Second Reading in the House of Lords, which starts next week.

It is expected that Baroness Williams, the influential Lib Dem peer who has "huge concerns" about the Bill, will lead the opposition with Lord Owen, a former health minister who has called the plans "fatally flawed", also likely to figure prominently in the debates.

The Shadow Health Secretary, John Healey, said: "David Cameron is in denial, both about the damage his plans are doing to the NHS and the strength of opposition to his Health Bill across the NHS."

"There is no mandate for the Bill, either from the election or the coalition agreement. With the government having railroaded its plans through the Commons, heavy responsibility is now going to be shouldered by the Lords."

David Cameron defended the reforms today.

Mr Cameron told ITV1's Daybreak: ''Of course there are doctors and others within the NHS that are wary about parts of our proposals, about greater choice for patients, about greater competition with the NHS.

''There have always been opponents to that, but the point of the exercise we held in the summer, when we paused and restarted the reforms, was to bring more of the health service on board, and many GPs, many doctors and many in the health service recognise that change is necessary if we are going to drive up standards in the health service, in which we invest and care about so much.''

He added: ''I think the reforms are right, I think they will improve patient care. Above all, they will be good for patients. They are going to give you more power and control over the care you get, a greater choice too, which I think patients will welcome.''

Labour has already organised a series of seminars for peers to get to grips with the mammoth legislation, which will create new quangos and a complex regulatory framework as well as abolishing two tiers of management.

Last week the Lords Constitution Committee gave warning that the reforms "risk diluting" the Health Secretary's ultimate responsibility for the NHS.

The number of eminent medics and crossbenchers in the upper house, along with restive Lib Dems, means that the Bill's passage cannot be guaranteed.

Today's letter was co-ordinated by Dr David McCoy, a senior clinical research fellow at University College London as well as a public health consultant in the NHS. He said he was been taken aback by the number of public health figures, including about 50 professors and the government adviser Sir Michael Marmot, who put their names to it in just a few days.

In a comment piece for the Telegraph website, Dr McCoy has explained why public health professionals - who aim to combat diseases and improve lifestyles across society - have such deep concerns about the Bill.

He writes: "Organisational disruption has resulted in huge amounts of money, time and energy being diverted from real work, including the sustained development of shared knowledge, understanding and trust across the different elements of the health care system, local government and communities - vital for the building of participatory and integrated responses to rising unemployment, youth alienation, fuel poverty, social inequality and homelessness.

"The relationship between public health and clinical care may also become more distant. At the moment, local public health and clinical budgets are mostly held together within Primary Care Trusts. But in the future, public health and clinical budgets will be spread across different organisations, potentially undermining the public health function of bridging clinical medicine with the social context and physical environment of families and patients. Cancer screening, immunisations and communicable disease control will become harder and more costly to deliver."

He denied that the opposition was down to basic fears about privatisation and admitted the NHS should not be a "monolithic" public sector organisation.

"The NHS can be decentralised and incentivised in many ways to ensure innovation, entrepreuneurialism and efficiency, and charities and third sector organisations are all private and vital to the delivery of public health goals."

A Department of Health spokesman said: "We are very disappointed that these individuals, who pride themselves in the use of evidence, should have fallen back into such generalised assertions for which there is not one shred of evidence.

"The reforms to public health arrangements are a once in a lifetime opportunity to put public health at the heart of local health plans.

"NHS staff and the general public are looking to senior leaders in public health to lead the implementation of the changes to secure better health results for all, not to rubbish them."