Changes in the NHS – initial thoughts


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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.

The BBC have a great ‘simple guide’ to the reforms and what they may mean.

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.

5 thoughts on “Changes in the NHS – initial thoughts

  1. Pingback: Changes in the NHS – initial thoughts - Fighting Monsters - Member blogs - Social Work Blog - Carespace from Community Care

  2. Sorry but i feel your worst fears will be confirmed we are going to be a pilot for the changes just after the change to payments by results already had 3 reconfigurations in the past 5 years it will cost a fortune and will disrupt joint working pct boundries match La’s nearly Gp consortia could be all over. No evidence anywhere that i can find that show this will lead to improvments for anyone.

  3. In my view, the most apparent way the market has influenced social care has been the way private equity firms have bought up many of the largest fostering agencies and residential care home groups. For me, the continued use of holding therapy by a private company in the UK is the most vivid example of the consequences of an unregulated market. Please see http://anyachaika.wordpress.com

  4. blackcat – yeah, pretty much my thoughts!

    anyachaika – thanks for the link and information. I wasn’t aware of this but will follow what you write with interest.

  5. Pingback: Health and Social Care Bill 2010/1 – some comments and not much hope | Fighting Monsters

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