The UK government is planning a propaganda campaign to try to defend health reforms critics say will destroy key aspects of the NHS.
Whitehall sources say that the Conservative-Liberal Democrat coalition will offer some concessions on their Health Bill, which is dividing their own ranks, and are unpopular with both the public and doctors, nurses and many health experts.
But PM David Cameron and Health Secretary Andrew Lansley remain ideologically committed to privatising and breaking up as much of the public health sector as possible.
But their proposals to radically restructure medical education and training, and public health services in England are flawed and could damage the NHS beyond repair, says the British Medical Association (BMA).
The proposals for public health are outlined in the government’s White Paper, Healthy Lives, Healthy People, and those for education and training are put forward in the White Paper, Liberating the NHS: Developing the Health Care Workforce.
In the BMA’s responses to both White Papers, there are recurring themes throughout, says BMA Chair of Council, Dr Hamish Meldrum.
He comments: “In these two final consultations related to the Health and Social Care Bill, we find, yet again, that the government is racing towards further fragmentation of the NHS."
“The proposals for public health are causing great anxiety among doctors who believe the plans are flawed and could lead to the NHS losing the skills and expertise of hundreds of highly trained public health doctors. These doctors are responsible for emergency planning such as developing systems during a pandemic flu crisis, developing projects to counteract unhealthy living such as obesity and alcohol misuse, and essential contributions to the commissioning plans for local health services," says Meldrum.
The BMA Council chief continues: “The plans for medical education and training could be very damaging to the NHS because of their lack of detail, the overly ambitious pace of change and the failure to consider effectively their impact on medical training and patient care. The future of the NHS is highly dependent on a properly trained workforce and we are very concerned that the plans outlined in the White Paper put the quality of training at risk."
“Moving away from a national – or, even better, a UK-wide - approach to the management of workforce planning is particularly worrying as it risks introducing a postcode lottery for medical training and ultimately patient care. At a time when so much change is planned for the NHS in England it would make more sense to build on the current system rather than embark on a revolution with hugely uncertain outcomes. We are also disappointed that the consultation paper has nothing to say about medical research despite the Government declaring it to be a priority. This is a missed opportunity to build on the UK’s success in medical research and education,” he says.
Doctors’ concerns about the public health White Paper are mainly related to fears over the future structure of public health services and the impending transition period, says the BMA response.
Public health doctors fear that the proposed new structure will break up the workforce and lead to the fragmentation of public health services. A better way forward, argues the BMA, is for all three areas of public health (health protection, health improvement and support for commissioning) to be employed by a single public health agency, and that this should be an NHS organisation.
Co-chair of the BMA’s Public Health Committee, Dr Richard Jarvis, said late last week: “It makes no sense for public health doctors to be employed by different organisations when they should be working together. The BMA fears that once the workforce is broken up in this way it will be damaged beyond repair.”
The BMA believes that the government’s plans for workforce planning could put the future of medical education and training in jeopardy.
Dr Tom Dolphin, Co-Chair of the BMA’s Junior Doctor Committee, added: “The last major upheaval of medical training, in 2007, culminated in the collapse of the application system for specialist training. Since then there has been a gradual improvement in the recruitment process based on small changes supported by evidence. The current proposals do not seem to provide proper oversight of medical training and there is great fear that the system for training doctors could slide into decline. The government’s plans will effectively abolish the postgraduate medical deaneries which provide important local scrutiny of the quality of medical training and ensure patient safety is not jeopardised by poor training.”
The BMA is urging the government to reconsider its proposals on the restructuring of public health and the future of medical education, training and research.
Further information on the BMA response to Healthy Lives, Healthy People is available here: http://www.bma.org.uk/healthcare_policy/public_health_white_paper/index.jsp 
On the BMA response to Liberating the NHS: Developing the Health Care Workforce, see: http://www.bma.org.uk/healthcare_policy/workforce_education_training_whi...