Resistance to proposals for National Health Service reform seems to be on the rise, with the latest critic, Diabetes UK, warning of fragmented care for patients with diabetes.

According to the charity, elements of the Bill - in particular competition and commissioning - pose a real danger of disrupting service integration and continuity of care and, in the absence of a single body healthcare body accountable for providing seamless care, patients with diabetes are at risk from a downturn in the quality of their care.

Diabetes and its complications already drag heavily on NHS purse strings, accounting for more than £9 billion a year, or £1 million an hour. And the consequences of failing to control the disease are extremely serious, leaving patients more vulnerable to stroke, heart and kidney disease, amongst other conditions, underscoring the importance of effective services.

But under the government's proposals, “different aspects of diabetes care could be commissioned by different bodies and services could fail to be joined up round the patient," warned Barbara Young, Diabetes UK's chief executive. "The continuity of care which is vital to people with diabetes risks being damaged by fragmented commissioning arrangements and competition policy that could undermine partnership working and integrated care,” she stressed.

In a submission to the Health and Social Care Bill Committee, the charity is lobbying the government to weave stronger duties into the Bill to ensure that all the commissioning bodies work together to provide integrated care, and that both patients and expert professionals are involved in the commissioning of integrated diabetes care services. 

In addition, it has called for the duties of new economic regulator Monitor to include the integration of services as well as the promotion of competition.

Young argues that opening up health service provision to competition as the Bill encourages "risks fragmentation of integrated services and networks of care as elements are delivered by different providers, especially those new to the healthcare economy".

Accountability too weak?

In an open letter to The Times last week, an alliance of charities - including the Alzheimer's Society and the British Heart Foundation, tore apart the government's health plans, claiming that "plans to make GP consortia accountable to the public are far too weak".

In addition, it accused the government for failing to put patients at the forefront as promised. "Greater patient and public involvement leads to better care and more efficient services yet the proposed reforms do little to give patients a stronger voice at a local level," the charities argue.

Another strong critic of elements of reform is the British Medical Association, which is totally against an NHS market, insisting that competition within the health system will only have a detrimental effect on patient care.

And giving evidence to the Bill Committee recently, Sue Slipman, director of the Foundation Trust Network, warned: "It is price competition that could drive down quality, certainly in the first years of a market such as this. All the evidence shows that there is a race to the bottom where there is price competition, and that is not desirable". 

The Office of Health Economics has established an expert Commission to look at if and where competition has a place in the National Health Service, or whether its impact is likely to be negative.