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Prime minister admits in speech to NHS staff that government has not explained planned changes well David Cameron has warned that the NHS will face a funding crisis without major changes and insisted reform was the only way to save the health service. The prime minister’s intervention, in a speech to NHS staff at Ealing hospital in west London, was seen by ministers as an attempt to reassure Tory MPs who fear the government’s NHS “listening exercise” is being driven by the Liberal Democrats. Cameron reached out to the medical profession by admitting the government had not explained its reforms effectively, and professed his love for the NHS. But he said the twin challenges of an ageing population and the need to save £20bn in NHS spending over the next four years – identified by the previous government – meant the status quo could not be maintained. He said the government would respond to the findings of Prof Steve Field’s “listening exercise” by the end of next month and indicated that ministers would take on board one of the main recommendations from a recent report by the Commons health select committee. Stephen Dorrell, the former health secretary who chairs it, has called for the “full institutional and managerial integration” of the NHS and social care in England. Cameron said: “Change … must tackle the longstanding and damaging divide between health and social care, including the bed blocking that still afflicts so many of our hospitals. It must assist with the challenge to increase efficiency, raise productivity and keep costs down so we can go on meeting everyone’s needs.” Other changes to the health and social care bill outlined by government include: • Wider membership for the GP-led consortiums which will replace primary care trusts. Hospital doctors and nurses will be more closely involved. • Competition will not be introduced to the NHS “for its own sake”, and there “will be choice for patients”, with no cherry-picking of services by private firms. • The changes will be evolutionary, not revolutionary. At the end of the process, the NHS will look reasonably similar and will not become a “space age institution”. • A controversial element of the bill to allow “any willing provider” will be changed to a “properly qualified provider”. The prime minister said: “Sticking with the status quo and hoping we can get by with a bit more money is simply not an option. If we stay as we are, the NHS will need £130bn a year by 2015 – meaning a potential funding gap of £20bn. “The question is, what are we going to do about that? Ignore it? No – because we’d see a crisis of funding in the NHS, overcrowded wards and fewer treatments. Borrow more so we can chuck more money at it? No – because we can’t afford to. “Ask people to start paying at the point of delivery for it? No – because, as I said, the NHS must always be free to those who need it. There’s only one option we’ve got, and that is to change and modernise the NHS to make it more efficient and more effective and, above all, more focused on prevention, on health, not just sickness.” Cameron added: “We save the NHS by changing it. We risk its long-term future by resisting change now.” The prime minister, who admitted that the government had failed to explain its reforms well, attempted to reassure the medical profession and voters who fear he plans to dismantle the NHS. “I know that some people still have concerns. They might be listening to this and thinking: ‘OK – but if you love the NHS so much, if you don’t want to take any risks with it, why do you want to change it? “But this is the point. It’s because I love the NHS so much that I want to change it, because the fact is the NHS needs to change. It needs to change to make it work better today and it needs to change to avoid a crisis tomorrow.” The prime minister said the Labour leader, Ed Miliband, accepted the need for change, adding that the government’s plans were a “logical development” of Labour’s reforms. These include payment by results, foundation trusts and the use of independent providers. Clinical commission has been around for two decades, he added. Cameron said: “The difference [with Labour's reforms] is that we plan to make these changes effective across our NHS. As I said – evolution, not revolution. That’s why, when I think about what our NHS will look like in five years’ time, I don’t picture some space age institution, a million miles away from what we have now. Let me make clear: there will be no privatisation, there will be no cherry-picking from private providers, there will be no new upfront costs people have to pay to get care. “Absolutely not. These are red lines we will not cross. Instead, our NHS will be much like what we have today.” Cameron wanted to use the speech to show that changes will be introduced to the social care bill and also to reassure Conservative MPs – who raised concerns at a meeting of the 1922 committee last week – that he is not being forced to change tack under pressure from the Liberal Democrats. The prime minister told that meeting he, and not the Lib Dem leader and deputy prime minister, Nick Clegg, had decided to pause the bill. Cameron also commended Field, who was present for the speech, for his independence of thought after he raised concerns about the original health reforms. Field praised the prime minister for sanctioning a “real listening exercise”.Field, chair of the NHS Future Forum, dismissed a Downing Street health adviser’s claim that the NHS would be reshaped into a provider of state health insurance. He said Mark Britnell – an NHS boss who now works for the accountancy firm KPMG – was “wrong” to back the idea of patients being charged to use the NHS and to predict it would be turned into “a state insurance provider, not a state deliverer”. Field told a “listening” event for Guardian readers held at the newspaper’s London offices: “If he’s saying that this is going to be a system that’s insurance-led then I haven’t heard any intention from anyone in government that this is what they want to do. I don’t think that politicians want to dismember the NHS in any way.” David Cameron is personally committed to the NHS, he stressed. A final report will be produced at the start of June by the forum of 44 experts examining the bill. “We will say something strong about the pace of change in some areas,” said Field. He also voiced concerns about the wide variation in the quality of care provided by some GPs, who under the health secretary Andrew Lansley’s plans are due to start commissioning £60bn of care for patients from 2013. NHS data could be used to help tell patients who were the better or worse-performing family doctors, Field added. Patients also needed to have much more of a say in the NHS, he said. NHS David Cameron Andrew Lansley Health Nicholas Watt Denis Campbell guardian.co.uk