Andrew Lansley vows to press on with controversial NHS reforms

Andrew Lansley, the health secretary, today vowed to push ahead with radical plans to shake up the NHS that will hand £80bn of taxpayers' money to GPs and offer managers the chance, for the first time, to join private companies in return for making the reforms work. The changes represent the biggest shift in power and accountability in the NHS's 62-year history and have come under fire from almost every part of the health service. Among those raising the alarm – in the 6,000 responses to the white paper – about the size and scale of the changes envisaged were the Royal College of GPs, the trade unions and the respected health thinktank the King's Fund. The British Medical Association said its concerns had been "disregarded". "There is little evidence the government is genuinely prepared to engage with constructive criticism of its plans for the NHS," said Hamish Meldrum, chair of the BMA. Lansley, appearing before the health select committee, had testy exchanges with MPs saying a "very large number of people" supported his vision. In the Commons Ed Miliband accused David Cameron of "broken promises", saying a pledge of above-inflation rises in funding will not be met. But the prime minister said he was "confident" the health budget would grow every year until at least 2015. The health secretary sugared the pill by giving the NHS another year to find the £20bn of efficiency gains. Those savings were supposed to be achieved by 2014 but the deadline will slip back a year later. At the heart of next month's "flagship" bill is the shift of £80bn of taxpayers' money into the hands of England's 35,000 family doctors, who operate as essentially private businesses. Lansley admitted he had conducted no surveys of GPs before launching the white paper – despite opposition from four in 10 doctors. He said he would abolish primary care trusts, which buy treatments on behalf of patients, by 2013. The country's 152 PCTs are already being "clustered" together into 35 bodies to make an immediate saving of 45% in costs. But in a letter from Sir David Nicholson, the chief executive of the NHS, to health managers it emerged that staff from these clusters would be allowed "to create social enterprises or joint ventures with private sector or civil society organisations" and sell their skills to groups of inexperienced family doctors charged with managing hundreds of millions of pounds of public money after 2013. Nicholson also warned managers the reforms "will be undertaken in a highly challenging financial context, and at a time when staff and leaders across the NHS face personal and professional uncertainty about their futures". Unison described the move as "engineered privatisation". John Healey, the shadow health secretary, said "this letter confirms GPs will need a lot of help with commissioning, with other people doing it for them. It opens the door for both the transfer of existing PCT staff and the involvement of big healthcare companies who've been gearing up for months for NHS work". The government envisages almost all of the NHS leaving public hands. Hospitals will have to gain foundation status, essentially off the government's books, in four years and GPs will be forced to band together to purchase hospital care and manage budgets to pay for it by 2012.