I am worried that the Guardian has not understood the significant danger that the government’s white paper for NHS reform poses to the health service (Matt Hancock lays out plan for reorganisation of NHS in England; NHS and social care blueprint; Editorial, 11 February). The proposals will facilitate – by the removal of “irksome bureaucracy” – the direct awards of contracts without tender. Since the market model with purchaser-provider split is to remain, what is effectively going to happen is an unregulated market, with a reduction in the transparency and accountability of the contracting process.
In addition, there are plans for providers, potentially private for-profit, to be on the boards of the new integrated care systems (ICS) and to play a significant role in needs assessments, despite their obvious conflicts of interest. The role of councils is diminished, and there is still no duty on the government to provide key services throughout England and to everybody. Each of the 42 ICS areas can decide their own priorities, heavily guided by providers and distanced from local community input.
It is vital that opposition to this white paper builds rapidly, as negative impacts are concealed by the easily approved concept of “integrated care”. The Guardian needs to help, and the opposition needs to do more than complain about the timing.
Dr Pamela Martin
• Jeremy Hunt is right that “NHS restructuring rarely works out as intended” (An NHS shakeup could be revolutionary – but only if staffing levels are boosted too, 16 February), but wrong if he sees integration with the NHS as a solution to the social care crisis – a crisis created by his party.
The English local authority in which I worked in the 1990s had more than 30 care homes for elderly people, a thousand home carers and a wide network of day centres. Staff had good terms and conditions, were well-trained and morale was high. There was fair means-testing for clients, and nearly all assessed need was met. We were ready to meet the challenge of an increasing elderly population. Integration with the health service was neither wanted nor needed. We talked to colleagues from housing authorities and the voluntary sector – informally on an almost daily basis, as well as in monthly joint planning meetings. It was a system that worked well, until the Conservative party dogma of market forces, privatisation and financial cuts destroyed it.
For social care to be incorporated into the NHS would create an overcentralised, bureaucratic service, subject to constant reorganisation and the vagaries of changing ministers. Social care should once again become a service, rather than a business, managed by local councils and assured of the necessary funds.
• Your editorial suggests that the largest example of the fragmentation of the health and care system is “the relative neglect of care homes in relation to hospitals”. It isn’t. It is the fact that we have an almost wholly socialised state healthcare system operating alongside almost wholly privatised social care provision. Until social care is removed from the market, any notion of integrating it with the NHS is utterly meaningless.
Former Labour MP and chair of the Commons health committee
• Jeremy Hunt tells us that our NHS is facing a big challenge from workforce shortages. Could this have anything to do with frozen NHS wages, the removal of nurse training bursaries and the imposition of inferior contracts on junior doctors – all under his ministerial watch?