I haven’t read the Health and Social Care Bill. I have glanced at it. I tried to look at anything connected with Mental Health and Social Care and there are a few bits and pieces nestled in there towards the end but the problem with reading primary legislation is that, well, it has a language all of it’s own and it isn’t a particularly easy read compared to White or Green Papers.
That’s my excuse out of the way.
I have, instead, read through some of the commentary about the Bill. I retain all my reservations. In fact, I have some increased ones about the role that the private sector is set to have in the healthcare ‘business’. I find it hard to comprehend how much of a dissonance from Cameron’s mealy-mouthed words about protecting the NHS through the election campaign and the Coalition Document’s promise of ‘No top-down reorganisation’ of the NHS.
Ah, say those whispering Tories, this is not ‘top-down’, this is ‘bottom-up’ reorganisation. So what, exactly, is the government imposing new systems and yet another reorganisation – if not ‘top down’.
I’m no great fan of much that the last government did so I can’t say Labour would be any better. It just feels so hopeless to cry into the night sometimes.
On a local level, we are losing beds and losing wards. That isn’t a far off fiction. That’s happening today. They probably haven’t been noticed because they are psychiatric wards and hospitals rather than cancer or paediatric beds but remember we were there to warn you.. sigh.. I wish it didn’t have to be that way.
Back to the Bill then
The Guardian has a good summary of the main points. Apart from the abolition of the PCT and the move to GP-led consortia bidding for services, there are to be a few regulatory quangos. One, Monitor, which currently.. um.. monitors Foundation Trusts will be beefed up as all Hospital Trusts will have to become independent Foundation Trusts.
Strange then that Monitor is one of the few health bodies that comes out in favour of the Bill. Their almost smug press release saying
Monitor strongly supports the Government’s proposals to move to a more devolved system for the NHS, with increased competition in healthcare, as set out in the Health and Social Care Bill…
In Monitor’s view, introducing more competition into healthcare is an important step in raising the productivity of the sector and delivering ever higher quality care for patients…
It has delivered significant benefits in other sectors and has been shown to improve quality within healthcare and other sectors under the right circumstances.
In particular we welcome the Government’s intention that we will become the economic regulator for health and adult social care.
I’m sure they do welcome the fact that they will be one of the few quangos to be beefed up. It does seem more than a little self-serving as a statement though. I worry that social care regulation has been bundled in to an extent. It’s always going to be clear where the priority lies (clue – it won’t be with social care when it competes to time, money and resources against health).
There is mention of the setting up of a body called HealthWatch which is supposedly some kind of ‘patient voice’. It’s reported to be some kind of ‘consumer champion’ service within the CQC. Well, that discredits it for a start as the CQC seems to be barely fit for purpose and working on less than acceptable staff ratios to keep the public safe.
My concerns remain about the process of commissioning, the welcoming of competition into a market that is not neutral and cost should not be the base denominator of best.
The process of change is tiring. I am no great fan of over-management but I can’t see how a public castigation of the higher echelons of an organisation makes it easier to stomach the change. Change does need to be managed, after all.
We, right at the very bottom of the tier, way below the GP commissioners, will be expected to carry out a better job with less time. I do wonder what will happen to us in secondary health care services. Will we be ‘value for money’?
How will our value be determined? On how much money we save the Trust by ‘keeping people out of now, non-existent hospital beds’?
A few points that I did pick up were that some of the tasks delegated to PCTs currently will be shifted to already pushed local authorities. There are some increased responsibilities for public health and more specifically to my interests, the provision of the IMHA (Independent Mental Health Advocates). I see that local authorities will take responsibility for s117 aftercare services. A tiny line in the Act but potentially a MASSIVE increase in cost. Wow. That’s going to have some implications for the budgets of some care services. Particularly where I work in older adults services.
(N.B s117 of the Mental Health Act 1983 (as amended 2007) compels PCTs (soon to be local authorities) to pay for care for the patient in the community following an detention in hospital under Section 3 of the Mental Health Act. In Older adults services, that can (not always) mean nursing and residential care. Where someone has dementia, they don’t ‘get better’ so the s117 funding remains in place indeterminately. So basically, it means that there will be a lot of funding consideration for the local authorities to pick up and it could mean a lot of care home fees for which no payment can be taken from the families).
The Bill also confirms the demise of the GSCC (General Social Care Council – which registers and regulates social workers in England) and authorises the HPC (Health Professions Council) to be renamed Health and Care Professions Council and to carry out the similar role. I remain basically ambivalent about this until I have reason to believe it may be better or worse than what we have at the moment.
Here’s what I think about the future. And it’s pretty bleak so you might want to look away now.
Private companies like Care UK – you know, the company that made a donation to Andrew Lansley’s private office – will run some of these GP consortia. It won’t be my GP making any choices. It certainly won’t be me making any choices. Cameron’s talk about choice is a red herring in my view.
The talk about choice in the Putting People First and personalisation agenda has been more or less a complete whitewash. Some people get A LOT more choice – those with capacity, those who are able, those with carers able to article what they want, but for the majority of people I work with, that vestige of choice is an illusion. They are getting the same carers, for the same cost carrying out the same tasks with more paperwork and higher criteria for accessing services.
So will be choice in the health service. Articulate and active participants, the ‘worried well’ and those who are able to shout loudest, will have the most choice.
The choice for those who have acute illness will always be limited. Do I trust my GP to make the best decisions for me? Not particularly. I live in an area where there are likely to be lots of involved interest groups with far louder voices.
Will my team be ‘competing’ with private companies able to specialise in managing some of the ‘more straightforward’ situations that we might deal with? Probably. I can certainly see adult care management services devolving now – indeed, that is already happening.
Will it make for better services? Possibly – and I say that with a heavy heart – for some people. The problem will lie with those that the private companies don’t want to ‘hive off’. They will have little choice and with the resources being pushed into reducing cost, possibly fewer resources.
I see this as a blueprint to increase health inequality and social inequality in England.
I’m not joking when I write this but I am considering moving to Scotland where at least I have family links. I wonder how easy it would be to pick up the Scottish legislation and switch my English registration for a Scottish one.. seriously, if anyone does know the answer to that, let me know!