The Mission and Public Affairs Council of the Church of England has published its response to the White Paper 'Equity and Excellence: Liberating the NHS'.

Whilst welcoming the ongoing commitment of the White Paper to "a comprehensive service, available to all, free at the point of use and based on clinical need, not the ability to pay", the response lists a number of criticisms.

In Section 2 the response looks at Limitations on Patient Choice, focusing on shared healthcare professional-patient decision-making, patients choosing where they receive treatment and the concept of the expert patient. "'Patient-centred' care ought not to be interpreted as 'self-centred' care, with each individual patient believing that he or she can make decisions without regard to the wider context in which care is provided," it says, adding that "promoting patient choice may result in inequality: skewing treatment towards the articulate and well-resources sections of society…" To avoid inequalities, patient education services would need to be supplemented with patient advocacy services".

In Section 3 the response criticises the proposal for GPs to have "new commissioning powers" for the majority of health services as "the healthcare professionals closest to patients": "Giving other health professionals [such as community pharmacists or community nurses] a statutory role to play in commissioning services would help to ensure that patients' needs are fully explored, assessed and addressed."

In Section 4 looks at The Importance of Good Management, acknowledging that "the NHS is 'overmanaged' but adding: "Giving health professionals, for example, a central decision-making role in commissioning does not mean that current management should be rendered obsolete or that health professionals ought to become managers."

Section 5 focuses on better coordination between health and social care, pointing out that "the mechanisms for achieving integrated care…are unclear and unnecessarily complex" and advocating a single commissioning body for integrated health and social care; while Section 6 warns there is a "real possibility that the proposals in the White Paper will result in the NHS being 'relayered' and becoming more, not less, complex.

Section 7 addresses aspects relating to Care Providers, looking at the proposition to encourage greater competition between healthcare providers "by enabling GP consortia to commission services from any group or organisation deemed to be competent. It warns that "…a Hospital Trust that 'loses' one service may discover that other services are affected or even rendered unsafe". With respect to end of life care, it recommends that an additional sixth domain dedicated to End of Life Care be added to those included in the consultation paper Transparency in Outcomes: a Framework for the NHS, with spiritual care "reflected as a 'cross-cutting' theme in all domains".

The full response is available here.