Norman Lamb threatens to quit as Nick Clegg’s adviser over NHS reforms
Changes proposed in the Health and Social Care Bill
The Health and Social Care Bill will see all 152 of England’s primary care trusts (PCTs) scrapped alongside 10 strategic health authorities.
GPs will be given around 80pc of the NHS budget – currently topping £100bn a year – to commission services for patients.
The plan is for consortia in Norfolk to start to take over some services in the coming year with the help of the PCTs, then in 2012-13 they will be leading with support from PCT, ahead of taking over completely in April 2013, which is when the PCTs will be scrapped.
Ian Mack, NHS Norfolk’s clinical executive committee chairman, said the idea was to strip out bureaucracy and “top down” targets, and replace them with local solutions.
He said: “An organisation led by clinicians and GPs will be flexible about how to deliver healthcare to improve health outcomes for their area. There’s much greater autonomy for what they can do.”
The cost of implementing the changes is £1.4bn, but Health Secretary Andrew Lansley insisted they would save the NHS more than £5bn by 2014/15 and £1.7bn every year thereafter.
Nationally, 24,500 jobs are expected to go, but it’s difficult to put a figure on things locally.
It’s thought that some of the 500-plus experienced staff working in commissioning for organisations like NHS Norfolk and NHS Great Yarmouth and Waveney will find new roles within the GP consortia.
Documents accompanying the bill outline how between 50pc and 70pc of SHA and PCT staff are likely to be retained and employed by the NHS commissioning board and the GP consortia.
There has been widespread concern over measures to increase competition between NHS providers and private companies.
The timing of the reforms has also been questioned – the NHS is currently trying to find £15bn to £20bn in efficiency savings.
Critics say the reforms could lead to a postcode lottery in which patients living in one area are denied a treatment provided to their neighbours.
Speaking on the BBC’s Politics Show today, Mr Lamb said the plans posed a major “financial risk” to the health service and patient care could suffer.
Ministers are consulting further on plans to cut middle managers, give GPs more control of budgets and encourage more competition.
But campaign groups including the British Medical Association and the Royal College of Nursing fear the Health and Social Care Bill will be the first step towards privatising healthcare.
Today Mr Lamb, who was the party’s health spokesman in opposition, said the proposed changes carried an “enormous political risk”.
He warned that the pace of change proposed by Health Secretary Andrew Lansley was “very risky”.
“As things stand I have very real concerns and I think it’s right for me to express those,” he said.
Mr Lamb insisted change in the NHS was necessary because of rising health costs and that GPs should be given a bigger role.
But he added: “It would be a crying shame if that really important principle was lost because we rushed the reform process and get it wrong.
“My real concern is the financial risk of doing it too quickly because then services and patient care suffers and the political risk is enormous, and most of all, for everyone who cares about the NHS and I think the Government does, we’ve got to get this right.”
He said there was “no evidence” about how the proposed GP-led commissioning bodies would work even though they are supposed to be up and running by 2013.
He called for the health reforms to mirror those in education, where schools are opting into academy status rather than being forced into it.
“Surely we should be doing an evolutionary approach in health as we are doing in schools,” he said.
“The principle at the core of this – of giving GPs more power and responsibility – is absolutely right.
“But whenever you introduce new structures, of course there is no evidence, so the sensible thing to do after this period of reflection is test it, see if it works, and it would gather a momentum of its own.
“If it works as we hope it would, then others would follow suit, but to do it in one fell swoop would be very risky.”
Ministers announced last week they were going to “pause” the health reforms amid widespread opposition among NHS professionals, patients groups and rank-and-file Lib Dems.
Mr Lamb said he welcomed that “period of reflection”, adding: “It should be possible for me to speak out about what I think should happen – evolution not revolution.
“That way I think the Government can get itself off the hook that it is on at the moment, it can get a lot of professionals back on board, and most of all it can reduce the financial risk.”
Asked whether it could be a resignation issue, he said: “I’ve said if it’s impossible for me to carry on in my position I will step down, I don’t want to cause embarrassment, but I feel very strongly about this issue.
“And I think it’s in the Government’s interest to get it right in the way that I suggest.”
Challenged that it would be destabilising to the Government if he walked out, he added: “It would be incredibly destabilising politically if we get this reform wrong.”
David Cameron has said he would not allow “any risks” to be taken with the NHS but also has insisted the “status quo is not an option” and changes are needed to improve services in the future.
But he said ministers would be holding a series of meeting with NHS staff and the public over the next couple of months to explain the Government’s vision for the NHS and to see if improvements could be made.
Today shadow chancellor Ed Balls said Mr Lamb’s comments were “very significant indeed”.
“Clearly Norman is very close to Nick Clegg, he’s his closest political and parliamentary adviser,” he told The Politics Show.
“He made a very important point, which is that we shouldn’t see reform as always good. There are good reforms and there are bad reforms.
“These are bad reforms, they are not popular, they won’t work, they will be destabilising financially and also in terms of treatment.
“What we don’t want is a pause or a PR initiative. What we want is the Government to say ‘we got this wrong’.”
Mr Balls added: “It’s good to see Norman Lamb is taking a stand as other Lib Dems are.”
Mr Cameron and Mr Lansley will co-host another public engagement event on Wednesday as they seek to tackle widespread anger about the proposals.
Lib Dem Chief Secretary to the Treasury Danny Alexander said the Government would come back with “substantive” changes to the Health and Social Care Bill.
“We have to go forward with reform which is about empowering people within the NHS to take more responsibility for themselves,” he said.
“It’s something where, of course there have been concerns raised by Liberal Democrats and elsewhere, and this listening exercise is a real opportunity for the Government to hear all those concerns.
“We intend to come back with serious, substantive changes to this Bill as a consequence of this process.”
He insisted putting GPs in charge was “the best way to get value for money in the NHS” but acknowledged concerns about the proposed GP-led commissioning authorities.
“I do think there are issues about the way in which these consortia will be governed and the way they will operate,” he said.
Ministers are to travel the country listening to complaints and concerns about the Government’s controversial NHS reforms.
“It’s time to pause, listen and reflect so we can improve the NHS we all know and love,” Mr Lansley said.
“Although we are increasing the NHS budget by £11.5 billion, demands are so great that we also need to modernise the NHS in order to sustain it for future generations.
“I encourage people to engage with our plans so that we have an NHS that is truly world class.”
