More than 90% of BMJ readers responding to a poll published today think the government's health reforms should be scrapped.

The poll asked: "Should the Health and Social Care Bill for England now be withdrawn?" A total of 2,947 votes were cast on bmj.com over the last 7 days. Of these, 2,706 said Yes, while 241 said No. The full results are now available at http://www.bmj.com/about-bmj/poll-archive

Dr Fiona Godlee, BMJ Editor-in-Chief said: "This poll reflects the extent of the opposition to this bill among doctors. We also have consistent anecdotal feedback suggesting that initial support for the aims of the government's proposed changes has haemorrhaged over the past year. Good people have left PCTs, and GPs are understandably unwilling to shift their role from patients' advocates to rationers of health care."

Meanwhile, Professor Martin McKee from the London School of Hygiene and Tropical Medicine says his "confusion is only deepening" over the proposed NHS reforms.

Last month, Professor McKee wrote to the BMJ asking: Does anyone understand the government’s plan for the NHS?

The Secretary of State, Andrew Lansley, replied, setting out why legislation is necessary for his health reforms. But in a letter published on bmj.com today, Professor McKee says his response "has raised additional questions in my mind, not least because in the 24 hours since his response was published he has published 137 amendments to the bill. I wonder if I am alone in struggling to keep up."

Professor McKee says he is reassured to know that the NHS will “remain free at the point of use” but is still unclear whether this covers those services, such as sexual health, that are being transferred to local government and therefore will no longer be “NHS.”

He also welcomes the description of who is responsible for various things, but points out that his confusion was shared by the House of Lords Constitution Committee, which stated that “it is not clear whether the existing structures of political and legal accountability with regard to the NHS will continue to operate as they have done hitherto if the Bill is passed in its current form.”

The argument that the reforms will increase the scope for frontline professionals to make decisions also seems strangely at odds with a commissioning structure that replaces three management tiers with five, he writes, while he is surprised to read that patient experience in the NHS is poor, given evidence from the Commonwealth Fund that the UK is first or second among 11 countries on many measures of patient centredness.

And, despite reassurances about privatisation of commissioning, he reads that “the NHS sector, which provides the majority of commissioning support now, needs to make the transition from statutory function to freestanding enterprise.”

Finally, he says he remains puzzled about how the legislation is needed to give confidence to the NHS given the results of the recent YouGov poll reporting that 80% of NHS staff expressing an opinion believe that the bill should be withdrawn.

"I am sure that, in time, I will manage to understand the reforms. Indeed, it may be that some of the answers are contained in the torrent of amendments being introduced to clarify the intentions of the bill, although this begs the question of why, if it was all so clear, they are now deemed necessary, he concludes. "Sadly, I fear that, for now, my confusion is only deepening."

In an editorial also published today, Chris Ham, Chief Executive at The King’s Fund argues that an important weakness in the continuing programme of health care reform in England "is the government’s failure to value the role of managers and to recognise the vital contribution they make alongside clinicians in ensuring the provision of high quality care."

He argues that putting doctors in charge of budgets "may bring some benefits but without the right support they are doomed to fail" and that, in the absence of effective management, "the performance of the NHS will suffer to the detriment of patients and the public."

Contacts:

Martin McKee, Professor of European Public Health, London School of Hygiene and Tropical Medicine, London, UK

Paula.Fentiman@lshtm.ac.uk or giorgio.defaveri@lshtm.ac.uk

Chris Ham, Chief Executive, The King’s Fund, London, UK

mediaoffice@kingsfund.org.uk