Labour accuses government of 'ploughing on regardless' with plans as letter talks of need to maintain momentum
The government has been accused of "ploughing on regardless" with its restructuring of the health service in England after the head of the NHS told staff to "maintain momentum" for the planned changes during the listening exercise being undertaken by ministers.
The timescale for implementing key parts of the health and social care bill, including handing over commissioning powers to GP groups from April 2013, remains the same despite the "pause" in the legislation going through parliament, according to David Nicholson, the chief executive of the NHS.
His message in a letter to colleagues will fuel concerns that the government's promise to take on board ways it might "improve" its plans during a "natural break" is little more than cosmetic.
Labour said it was clear ministers planned to make little change, the head of the Royal College of Nursing (RCN) warned against "things ploughing on", and the leader of the British Medical Association said the government must not make "irreversible" decisions.
Nicholson's letter was dated 13 April, the day the health secretary, Andrew Lansley, echoed the deputy prime minister, Nick Clegg, in promising "substantive changes" to the legislation and apologised to members of the RCN for not communicating what he was setting out to do. It was sent days after the Guardian revealed Nicholson had already indicated in a confidential memo that there may be little room for manoeuvre in changing the bill. There are also reports that David Cameron takes his advice rather than Lansley's.
Nicholson's letter stressed "very firmly that we need to continue to take reasonable steps to prepare for implementation and maintain momentum on the ground". He admitted pressing on while increasing "levels of engagement" on the plans might seem paradoxical" – but denied it was – and stressed the importance of pathfinder bodies preparing for the changes to be at the heart of the process "because recent progress on the transition has been strong".
Nicholson recognised planning might change "subject to the results of the listening exercise" but the NHS continued to aim for the abolition of primary care trusts by April 2013 and for hospital trusts becoming foundation trusts by April 2014.
There would, however, be a delay of at least three months, to July 2012, in statutory changes, including the abolition of strategic health authorities. Nicholson said many thousands of GPs, nurses, other clinicians and support staff were already involved in pathfinder consortia "now covering 88% of the population and proceeding ahead of schedule". Nine in 10 local authorities had signed up to be "early implementers" of local health and wellbeing boards, according to the letter.
Nicholson also warned that NHS bodies to be abolished by the reforms must ensure "sustainable solutions" over the coming year if they had deficits so successor organisations did not inherit debts or underlying financial problems.
He said: "I know that to some the message to press on with implementation while significantly increasing our levels of engagement on our plans may seem paradoxical. I don't believe that it is. Engaging, learning and adaptation should always be at the heart of effective implementation: good engagement is central to making change happen, it is not an alternative to change."
John Healey, Labour's shadow health secretary, said: "This will do little to convince people that David Cameron's promise of a 'listening exercise' is anything other than a PR stunt. It is clear from this letter that the Department of Health is planning for the health bill to go through largely unchanged, and that the government is set to plough ahead with its NHS reorganisation regardless of what ministers hear in the next few weeks."
Peter Carter, chief executive and general secretary of the RCN, said: "Overall it is a very confusing picture. We have got a pause and things seem to be ploughing on. Next week we are going to have to ask for clarification. Otherwise it is going to continue the kind of view some people have, that this is a bit of a cynical exercise to take the heat out of the situation."
Hamish Meldrum, chair of the council of the BMA, said it had "always maintained that changes in the NHS must not anticipate the legislative process and lead to irreversible decisions or unnecessary risks if some or all of the health bill is not implemented.
"This is even more important given the delay created by the listening exercise which, if it really does indicate a willingness to listen and, more importantly, to make significant changes, may result in several elements of the policy being altered or delayed," he said.
The Department of Health said: "The message is clear. The principles remain the same but improvements will be made as we pause, listen and reflect."