UK:危うい NHS & Social Care 改革：Social Policy の視点から：So-netブログ

The UK's largest medical royal college has called for the prime minister to scrap the health and social care bill, branding it "damaging, unnecessary and expensive".

The Royal College of General Practitioners (RCGP) has written to David Cameron following the tabling of amendments to the controversial bill in the House of Lords this week.

They said that despite the amendments, they believed the planned reform would "cause irreparable damage to patient care and jeopardise the NHS".

The RCGP chairwoman, Dr Clare Gerada, said: "This decision was not taken lightly, but it is clear that the college has been left with no alternative.

"We have taken every opportunity to negotiate changes for the good of our patients and for the continued stability of the NHS, yet while the government has claimed that it has made widespread concessions, our view is that the amendments have created greater confusion.

"We remain unconvinced that the bill will improve the care and services we provide to our patients."

The college, which represents more than 44,000 family doctors, said three-quarters of respondents to a recent poll said they thought it appropriate to seek the withdrawal of the bill.

It wrote to the health secretary, Andrew Lansley, to voice the concerns of their members but decided to take action after receiving his response, and following the government's tabling of amendments on Wednesday.

Gerada said: "Our position has not changed, and the concerns we expressed when this bill was at the white paper stage 18 months ago have still not been satisfactorily addressed.

"Competition and the opening up our of health service to any qualified providers will lead not only to fragmentation of care, but also potentially to a 'two-tier' system with access to care defined by a patient's ability to pay."

The 20 colleges that make up the Academy of Medical Royal Colleges have been divided over the strength of the stance they should take against the bill.

Those opposing it include the Royal College of Radiologists, which said it had "grave concerns", and the Royal College of Psychiatrists, which called the bill "fundamentally flawed".

The British Medical Association, the Royal College of Nursing and the Royal College of Midwives have also called for the bill to be withdrawn.

The government has been criticised for failing to allay fears over an increased role for private companies in running the NHS.

A critical report from MPs on the health committee last month said the overhaul was hindering the ability of the NHS to make the savings it needs to safeguard its future.

One of the amendments laid out this week said the NHS commissioning board and clinical commissioning groups run by GPs would have new responsibilities to support education and training. Both will also have to report annually on their progress in tackling health inequalities, together with the health secretary.

Lansley said the government had been "carefully listening" to opinions about the bill and that the series of amendments would "address these remaining issues".

Gerada added: "Our view is that what is required now is to rapidly consolidate the current organisational structure, such that PCT [primary care trust] clusters remain, with GPs placed as the majority of the board so that we may address the serious issues facing our NHS.

"There should be a debate as a matter of urgency to determine what the NHS can provide, how it should be funded, and how we deal with the major health and social care problems facing our population.

"We cannot sit back. Instead, we must once again raise our concerns in the hope that the prime minister will halt this damaging, unnecessary and expensive reorganisation, which, in our view, risks leaving the poorest and most vulnerable in society to bear the brunt."

She said the college could not support a bill that would "ultimately bring about the demise of a unified national health service".

Gerada told BBC Radio 4's Today programme: "This bill is a burden. It makes no sense, it is incoherent to anybody other than the lawyers. It won't deal with the big issues that we have to deal with, such as the ageing population and dementia.

"It will result in a very expensive health service and it will also result in a health service that certainly will never match the health service that we have at the moment – or at least had 12 months ago."

She rejected ministers' claims that GPs were enthusiastic about the reforms: "GPs do want to be part of the planning of services for their patients – absolutely, we have never ever been critical of that.

"But that is one thing. Delivering it through this cumbersome bill is not what GPs want. Over 90% of my members surveyed last month wanted me to ask for withdrawal of the bill.

"It will turn the National Health Service into thousands of different health services, all competing for the same patients, the same knee, the same brain, the same heart.

"Patients will find their care will be fragmented, it will be on different sites, it won't join up, it will be difficult to hand over care and it will be phenomenally expensive to keep track of all these competing parts of the NHS."

Gerada said the NHS was "one of the cheapest health services to run and one of the fairest health services" in the world.

"There is absolutely no evidence that opening up the NHS to multiple private organisations is going to result in anything other than a fragmented, expensive and bureaucratic health service for all of us, and one that will be very difficult to sort out and put back into a coherent form," she said.