Intended for healthcare professionals

Feature NHS reforms

NHS rethink: charade or cause for new hope?

BMJ 2011; 342 doi: (Published 28 June 2011) Cite this as: BMJ 2011;342:d3995

We asked a range of commentators from clinicians to academics for their thoughts on the proposed changes to the NHS Health and Social Care Bill. Do the changes move us to a healthcare model we can be proud of or do they take us back to pre-1948 inequity and a “return to fear”?

Kate Arden, director of public health, Wigan

I’ve been a chief officer in the local authority for three years now. If you are a doctor who has “grown up” in the NHS don’t underestimate what a big culture change it is moving to local government. You will need to influence cabinet and understand how local authorities work. Public health professionals will be coming into local government at a time of huge cutbacks and will have to negotiate that change and continue doing their job. It is going to be a real leadership challenge to keep them motivated. But I do think public health’s proper home is in local government—the key thing is not to lose precious links with the NHS.

I’m glad that Public Health England is to be an executive agency. Public health has to be seen as independent—you sometimes have to give advice, even when people don’t want to hear it. Public trust in scientific advice really took a battering during the bovine spongiform encephalopathy (BSE) crisis of the 1990s, and later with the MMR vaccine scare. I remember Liam Donaldson saying that as chief medical officer you have to be trusted as a politician, have a good relationship with the profession, but also be trusted by the public as the nation’s doctor. That’s hard.

John Black, president of the Royal College of Surgeons

The government should take great credit for taking time to listen to concerns from healthcare professionals and patients over the detail of the health reforms. Amendments to formally include hospital doctors in commissioning will help ensure all …

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