Paediatricians oppose Health and Social Care Bill
We are writing as paediatricians and members of the UK’s Royal College of Paediatrics and Child Health to call for England’s Health and Social Care Bill to be withdrawn. If passed, we believe that the Bill will have an extremely damaging effect on the health care of children and their families and their access to high-quality, effective services. We see no prospect for improvement to the Bill sufficient to safeguard the rights of access to health care by children and their families. In our view, no adequate justification for the Bill has been made. The costs of dismantling existing National Health Service (NHS) structures are enormous and, at a time of financial austerity for all public services, have resulted in precious resources being diverted to private management firms and away from front-line patient care.
We believe that the Bill will undermine choice, quality, safety, equity, and integration of care for children and their families. The NHS outperforms most other health systems internationally and is highly efficient. The 2010 Commonwealth Fund report on seven nations ranks the UK second overall and best in terms of efficiency and effective health care.1 Competition-based systems are not only more expensive and less efficient but are associated with gross inequality in perinatal and child health outcomes, including child safeguarding.2,3 Far from enabling clinicians to control and determine local services, the new commissioning proposals are more likely to lead to increased power for private management organisations attracted to this lucrative opportunity to manage small Clinical Commissioning Groups.
Multiple private providers will make it difficult to innovate, cooperate, plan, and improve the quality in children’s services for which collaboration and integration are fundamental and the cornerstone to adequate safeguarding of our children. The Bill will be detrimental to the goal of integrating care for the most vulnerable children across health, education, social care, and the criminal justice systems in order to deliver good outcomes.
Care will become more fragmented, and families and clinicians will struggle to organise services for these children. Children with chronic disease and disability will particularly suffer, since most have more than one condition and need a range of different clinicians. A family with a disabled child will find it more difficult and complicated to organise a complex package of care, because integrated working between the NHS and local authorities will become much harder to achieve.
If different services are commissioned from separate providers, this risks the breakdown of the relationships that underpin good communication and coordination, particularly where different aspects of service are provided from different budgets. This will happen because individual local authorities will relate to several Clinical Commissioning Groups, and vice versa, meaning that contracts will have to be negotiated between multiple providers, multiple commissioners, and multiple local authorities.
Safeguarding of children will become even more difficult when services are put out to competitive tender and organisations compete instead of cooperate. Children who are vulnerable, neglected, or abused will inevitably slip through the net.
The Bill is misrepresented by the UK Government as being necessary and as the only way to support greater patient choice and control. On both counts that claim does not stand up to scrutiny.4 Far from increasing choice, there is plenty of evidence amassing that these proposed reforms will in fact limit choice for all children and their families, increase inequalities, and harm those who are most vulnerable. Continuous quality improvement in our already high-quality NHS does not require this legislation.
Children and their families will be worse-off because of the Health and Social Care Bill. Our training, clinical expertise, and professional commitment to securing health and wellbeing for all children leads us to join with many others working to protect the interests of families and their children to call on the Government to drop this Bill.
February 17, 2012
See Online for webappendix
SL and the 154 signatories (see webappendix) are all members of the Royal College of Paediatrics and Child Health, London, UK. We declare that we have no conflicts of interest. The views expressed in this letter are those of the authors and not of the Royal College of Paediatrics and Child Health.
Stuart Logan on behalf of 154 signatories
Institute of Health Service Research, Peninsula College of Medicine and Dentistry, University of Exeter, Exeter EX2 4SG, UK
1 Davis K, Schoen C, Stremikis K. Mirror, mirror on the wall: how the performance of the US health care system compares internationally: 2010 update. London: The Commonwealth Fund, 2010.
2 Murray CJ, Frenk J. Ranking 37th—measuring the performance of the US health care system. N Engl J Med 2010; 362: 98–99.
3 Starfield B. Is US health really the best in the world? JAMA 2000; 284: 483–84.
4 Pollock AM, Price D, Roderick P, et al. How the Health and Social Care Bill 2011 would end entitlement to comprehensive health care in England. Lancet 2012; 379: 387–89.