I’ll write more about the government proposals to reform the NHS after the Health and SOCIAL CARE Bill is published tomorrow. Oh yes, did anyone pick up that slight subtlety there that it is supposedly covering social care as well as health.. sneakily hidden in.. er.. the title of the bill. You wouldn’t have thought it.
But I shouldn’t be too cynical. That’s just the way that social care has and will roll.
Most of my reservations are about the introduction of GP-led commissioning – so I’ll focus on that today.
I know it’s presented as being about more choice and more efficient services – but, as I’ve said before, when the Tories introduced the so-called needs-led agenda of the NHS and Community Care Act in 1990, the talk was about improving efficiency, cutting costs and providing more choice – hmm, those words seem familiar.
What were we left with?
Centrally commissioned services that led to ‘bidding wars’ and reverse auctions so that the company that could provide the service at the lowest cost would ‘win’ the contract. No choice – perhaps less choice as the cheapest options had to be sought regardless of quality.
Why does no-one look to the lessons that should have been learnt from the care sector? I know, there are some wonderful services out there and I don’t want to be dismissive but I feel strongly about the introduction of ‘the market’ to the care sector and I feel equally strongly about the potential failure of ‘the market’ in the health sector.
The US is hardly a glowing example of an efficient and cost-effective health care system after all.
I am not sure I buy into this ‘choice above all’ agenda. Choice is always going to be limited by cost. On a personal level, I live in one of the most deprived areas of the country. I don’t ‘know my GP by his name’. I don’t even necessarily trust the practice. My current GP practice was ‘taken over’ by the PCT (Primary Care Trust) for a while because of poor management and a few… financial shenanigans that led to all the doctors in the practice being dismissed. That’s a pretty big deal.
I wonder how a similar scenario would ‘play out’ in the ‘new world’ – where there is no PCT to ‘take over’. But Lansley and Cameron probably haven’t considered those kinds of scenarios. I just hope they remember that we don’t all have local village practices that we’ve been with for years and where everyone knows us and smiles at us in the street.
There are some of us living in very poor areas where some of the chronic health problems that are linked to poverty will very obviously and quite rightly take priority.
So would I get the same treatment for a more minor ailment and a lower priority ‘condition’ as someone in Knightsbridge? I’m not convinced.
Even less convinced because it won’t be my GP who is commissioning – it will be a private company that is hired by my GP. It will likely be the same people who worked in the PCT re-employed by companies like Care UK (a coincidence that they bankrolled Lansley’s private office?). So it’s likely to be the same people, doing the same job (probably for less money) but for the benefit of shareholders rather than the public purse.
I don’t want to be a grumpy naysayer. I want the NHS to work and to work better.
I am worried though.
I await the publication of the Health and Social Care Bill with trepidation.
I have reconfiguration fatigue already. The amount of money my Trust must have spent on change, and more change and even more change and then some more adjustments to that change would probably fund another ward. Or have retained one of the few that have closed.
I want ideas that work. I want a system that works. I am just very sceptical. Perhaps it is up to the government to prove me wrong. I hope I am wrong.
- Health chiefs issue stark warning over damaging effect of NHS reforms (guardian.co.uk)
- NHS reform ‘could shut hospitals’ (bbc.co.uk)
- David Cameron to sell NHS reforms with glowing tribute to doctors and GPs (guardian.co.uk)
- NHS upheaval unnecessary, GPs say (bbc.co.uk)
- Medical professionals warn against “extraordinarily risky” NHS reform (newstatesman.com)