Thinktank chief Chris Ham calls on David Cameron and Nick Clegg to end uncertainty over reform
David Cameron and Nick Clegg have been told to end their public "arm-wrestling" over the NHS because their divisions are worrying health professionals.
They should resolve the coalition's deepening difficulties on the issue and make the service's future clear as soon as possible.
The sharply-worded intervention in the increasingly fractious debate between the Conservatives and Liberal Democrats comes from Prof Chris Ham, chief executive of the King's Fund health thinktank and a member of Downing Street's "kitchen cabinet" on health policy.
"These arguments between the political leaders are worrying and unsettling people in the NHS. If you are running a hospital or primary care trust or pathfinder consortium of GPs you are now very unclear about the direction that the government is going in on these reforms," Ham said.
"Everything is back in the melting-pot. We are worried about the adverse effects on the NHS if this current uncertainty continues much longer."
Ham – a former director of the Department of Health's strategy unit – added: "With these very public disagreements between the coalition partners it's hard to know what direction will be taken on key issues such as choice and competition versus more integrated care.
"It's got down to arm-wrestling between the coalition partners to try and resolve the disagreements over the core elements of the proposed reforms.
"It's time for the government to stop wavering and start leading the NHS into whatever future they decide it should have when the arm-wrestling has finished."
Ham's remarks reflect growing frustration among NHS leaders that its future is shrouded in so much uncertainty after health secretary Andrew Lansley's health and social care bill has been "paused" because of its deep unpopularity.
They come on the day that the NHS Future Forum, the group of experts under Prof Steve Field which Cameron asked to review Lansley's plans, meets to discuss its report, which it will send to Cameron, Clegg and Lansley next week, and the day before the kitchen cabinet's latest meeting with Paul Bate, Cameron's health adviser.
But the forum is facing internal tension over the controversial issues of competition in the NHS. Sir Stephen Bubb, who is leading that 'workstream' within the group, is advocating an expansion of competition while Field, its chairman, wants to remove proposals in the Bill for the NHS regulator to oblige hospitals to compete with each other as he fears it would threaten the viability of key services in both large and small hospitals.
The King's Fund criticises Cameron and Lansley for failing to persuade health professionals or the public why the NHS needs to undergo the radical reorganisation they have been advocating.
Its submission to the government's "listening" exercise on the NHS states: "One of the reasons the coalition government has run into difficulty is that it moved very rapidly to set out radical changes to the NHS without having first clarified the problems that these reforms were meant to address."
It proposes greater integration of different types of healthcare as the NHS's key priority to cope with major challenges such as the ageing population and growing number of people with one or more long-term health problems. But it adds: "The coalition government's proposed reforms have the potential to help overcome some of the barriers [to that] but they could also make it more difficult to achieve closer integration of care unless they are modified in a number of ways."
Meanwhile, leaders of the voluntary sector have written to Cameron voicing serious concern that their organisations will be frozen out of providing health services unless the bill is amended.
The National Council for Voluntary Organisations (NCVO) wants "robust mechanisms" to oblige consortiums of GPs to act on advice from local health and wellbeing boards and branches of the planned HealthWatch network of patient support organisations about which healthcare providers are best-placed to treat patients.
"We urge the government to strengthen the measures in the bill to ensure that GP consortia incorporate the expertise and knowledge of their local voluntary and community sector in their thinking", said Sir Stuart Etherington, NCVO'schief executive. The third sector already provides £3.39bn of health and social care, he added.
National Voices, an umbrella group representing over 100 charities, has written to Field's group outlining nine key principles of NHS reform, including the urgent integration of services to benefit patients.
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