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Paediatricians say: Drop the NHS Bill or you will damage children's health

In a letter to The Lancet 154 leading paediatricians call on the government to drop the Health and Social Care Bill

ourKingdom editors
17 February 2012

In a letter to The Lancet 154 leading paediatricians urge the government to drop the Health and Social Care Bill

We are writing as paediatricians and members of the UK’s Royal College of Paediatrics and Child Health to call for England’s Health and Social Care Bill to be withdrawn. If passed, we believe that the Bill will have an extremely damaging effect on the health care of children and their families and their access to high-quality, effective services. We see no prospect for improvement to the Bill sufficient to safeguard the rights of access to health care by children and their families. In our view, no adequate justification for the Bill has been made. The costs of dismantling existing National Health Service (NHS) structures are enormous and, at a time of financial austerity for all public services, have resulted in precious resources being diverted to private management firms and away from front-line patient care.

We believe that the Bill will undermine choice, quality, safety, equity, and integration of care for children and their families. The NHS outperforms most other health systems internationally and is highly efficient. The 2010 Commonwealth Fund report on seven nations ranks the UK second overall and best in terms of efficiency and effective health care. (1) Competition-based systems are not only more expensive and less efficient but are associated with gross inequality in perinatal and child health outcomes, including child safeguarding. (2,3) Far from enabling clinicians to control and determine local services, the new commissioning proposals are more likely to lead to increased power for private management organisations attracted to this lucrative opportunity to manage small Clinical Commissioning Groups.

Multiple private providers will make it difficult to innovate, cooperate, plan, and improve the quality in children’s services for which collaboration and integration are fundamental and the cornerstone to adequate safeguarding of our children. The Bill will be detrimental to the goal of integrating care for the most vulnerable children across health, education, social care, and the criminal justice systems in order to deliver good outcomes.

Care will become more fragmented, and families and clinicians will struggle to organise services for these children. Children with chronic disease and disability will particularly suffer, since most have more than one condition and need a range of different clinicians. A family with a disabled child will find it more difficult and complicated to organise a complex package of care, because integrated working between the NHS and local authorities will become much harder to achieve.

If different services are commissioned from separate providers, this risks the breakdown of the relationships that underpin good communication and coordination, particularly where different aspects of service are provided from different budgets. This will happen because individual local authorities will relate to several Clinical Commissioning Groups, and vice versa, meaning that contracts will have to be negotiated between multiple providers, multiple commissioners, and multiple local authorities.

Safeguarding of children will become even more difficult when services are put out to competitive tender and organisations compete instead of cooperate. Children who are vulnerable, neglected, or abused will inevitably slip through the net.

The Bill is misrepresented by the UK Government as being necessary and as the only way to support greater patient choice and control. On both counts that claim does not stand up to scrutiny. (4) Far from increasing choice, there is plenty of evidence amassing that these proposed reforms will in fact limit choice for all children and their families, increase inequalities, and harm those who are most vulnerable. Continuous quality improvement in our already high-quality NHS does not require this legislation.

Note: We are all members of the Royal College of Paediatrics and Child Health, London, UK. We declare that we have no conflicts of interest. The views expressed in this letter are those of the authors and not of the Royal College of Paediatrics and Child Health.


Professor Stuart Logan

Professor Carol Dezateux

Professor John O Warner

Professor Ruth Gilbert

Professor William McGuire

Professor Imti Choonara

Professor Adam Finn

Professor Russell Viner

Professor Allan Colver

Professor Michael Levin

Professor Christopher J H Kelnar

Professor Ian Booth

Professor James V Leonard

Professor Jo Sibert

Professor Colin Kennedy

Professor David Dunger

Professor Timothy Barrett

Professor Nick Spencer

Professor Selena Gray

Dr Christine Arnold

Dr Helen Bantock

Dr Belinda Bateman

Dr Helen Bedford

Dr Rachel Besser

Dr Emma Blake

Dr Cliona Ni Bhrolchain

Dr Jo Blair

Dr Bernie Borgstein

Dr Jean Bowyer

Dr Joe Brierly

Dr Martin Brueton

Dr Deborah Burns

Dr Paul Carter

Dr Anupam Chakrapani

Dr Michael Champion

Dr Richard Chin

Dr Paul Clarke

Dr Helen Coleman

Dr Andrew Collinson

Dr Simon Court

Dr Julian Cox

Dr Anthony Cronin

Dr Suleman Daud

Dr Geoff DeBelle

Dr David Elliman

Dr David Edwards

Dr Fiona Finlay

Dr Emma Footitt

Dr Mary Gainsborough

Dr Penny Gibson

Dr Paul Gissen

Dr Paul Gorham

Dr Paul Gringras

Dr Dougal Hargreaves

Dr Val Harpin

Dr Neil Harrower

Dr Doug Heller

Dr Deborah Hodes

Dr Jennifer Holman

Dr Karen Horridge

Dr Tony Hulse

Dr David Inwald

Dr Lyda Jadresic

Dr Nicola Jay

Dr Diana Jellinek

Dr Glyn Jones

Dr Rosemary Jones

Dr Lisa Kauffmann

Dr Rowan Kerr‐Liddell

Dr Rachel Knowles

Dr George Kokai

Dr Thoma Kus

Dr Peter Lachman

Dr Gabrielle Laing

Dr Raman Lakshman

Dr Bill Lamb

Dr Vic Larcher

Dr John Livingston

Dr Wynn Leith

Dr David Mabin

Dr Chloe Macauley

Dr Aidan Macfarlane

Dr Donald Macgregor

Dr Heather Mackinnon

Dr Katie Mallam

Dr Astagi Manjunuth

Dr Donal Manning

Dr Jo Mannion

Dr Antoinette McAulay

Dr Liz McCaughey

Dr NJ McLellan

Dr Judith Meek

Dr Melanie Menden

Dr Alastair Morris

Dr Andrew Morris

Dr Sarah Morris

Dr Gail Moss

Dr Paul Munyard

Dr Anne Nesbitt

Dr Margaret O'Connom

Dr Stéphane Paulus

Dr Juliet Penrice

Dr Mark Peters

Dr Rajesh Phatak

Dr Ximena Poblete

Dr Max Priesemann

Dr Michael Quinn

Dr Richard Reading

Dr Anna Redfearn

Dr Ashley Reece

Dr Jane Ritchie

Dr Gareth Roberts

Dr Jane Roberts

Dr Sophie Robertson

Dr Peter Robinson

Dr David Taylor‐Robinson

Dr Glynn Russell

Dr George Rylance

Dr Clive Sainsbury

Dr Jane Schulte

Dr Neela Shabde

Dr Nawfal Sharief

Dr Peta Sharples

Dr Mark Sharrard

Dr Catherine Sikorski

Dr Mirsada Smailbegovic

Dr Donatella Soldi

Dr Ron Smith

Dr Alan Stanton

Dr Colin Stern

Dr Barbara Stewart

Dr John Storr

Dr Anthony Tam

Dr Adam Tilly

Dr Richard Tozer

Dr Catherine Tuffrey

Dr Gill Turner

Dr Francine Verhoeff

Dr Maybelle Wallis

Dr Martin Ward‐Platt

Dr Tony Waterston

Dr Paul Whitehead

Dr Jane Williams

Dr Richard Williams

Dr Ingrid Wolf

Dr Celia Wylie

Dr Sue Zeitlin

Dr Pam Zinkin

Dr Simon Lenton

Dr Poonam Dhamaraj

Dr Ian Pollock

Dr Victoria Jones

Dr Simon Ackroyd



(1) Davis K, Schoen C, Stremikis K. Mirror, mirror on the wall: how the performance of the US health care system compares internationally: 2010 update. London: The Commonwealth Fund, 2010.

(2) Murray CJ, Frenk J. Ranking 37th—measuring the performance of the US health care system. N Engl J Med 2010; 362: 98–99.

(3) Starfield B. Is US health really the best in the world? JAMA 2000; 284: 483–84.

(4) Pollock AM, Price D, Roderick P, et al. How the Health and Social Care Bill 2011 would end entitlement to comprehensive health care in England. Lancet 2012; 379: 387–89.


With thanks to The Lancet.

Published Online

February 17, 2012


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