Mar 132011

Because of what I do for a living, I have a pretty decent understanding not only of how the NHS has worked throughout the past couple of years, but also of how it is envisioned to work under the reforms now being discussed in the Commons.

And I do not see that these reforms amount to selling off the NHS piecemeal and having sick people dying in the streets.

What I see, primarily, is two things.

First, a step is being eliminated in the commissioning process with the abolition of the PCTs. This doesn’t mean that GPs themselves, with all of their other workload, will also be sending the commissioning paperwork to the secondary care providers; it means that the PCTs will be, in effect, split and absorbed into the newly-forming GP consortia. These consortia are groups of GPs who have voluntarily banded together because they share a geographical area or a particular patient demographic and thus have excellent collective knowledge of the populations whose health they deal with. These GP consortia are already consulting deeply with their PCTs and, from what I’ve heard, most plan to absorb not only the function but also many of the staff.

This restructuring, therefore, allows voluntary groups with similar knowledge to take responsibility for commissioning the healthcare appropriate to that knowledge and to those patients. This is a massive improvement on the PCTs, which are region-based and have no frontline exposure to the population and patient groups in their regions.

Second, all NHS trusts are being compelled to become, or join, foundation trusts. For those not familiar with foundation trusts, they are locally-established and locally-accountable, fiscally independent hospital or healthcare trusts. They are governed, ultimately, by a membership consisting of local people, and they are required to demonstrate the involvement of that membership in major decisions. This makes foundation trusts both more democratic and more responsive. Some of the best trusts in this country—such as Guy’s at St Thomas’s—are foundation trusts and have been since the Labour government brought in the concept.

Every other part of these reforms is incidental and, incidentally, is what seems to have the “Save the NHS” and “N4S” (Not 4 Sale) campaigners so worked up. OMG, there will no longer be a cap on private-patient income for foundation trusts! So what? FTs can’t make those kind of changes without the agreement of their membership. And if the membership wants the FT to take more private patients, who are you to stop them? OMG, care might be given by non-NHS providers! So what? GPs are not technically part of the NHS; neither are care homes, many mental health centres, many home carers, and so on. Provision doesn’t have to be done by NHS bodies, and there is no proof whatsoever that private providers will give a lower standard of care, or that NHS commissioners will choose the cheapest private providers at the expense of patient wellbeing.

In fact, lately there have been a lot of, erm, questions (let’s be nice about it) surrounding the quality of care the NHS itself provides, particularly when it comes to (a) old people and (b) hospital-acquired infections, and therefore I see no reason to cling so tightly to this idea that NHS provision is automatically a good, or better, circumstance for patients.

In the end, none of these reforms alter the vital fact that the NHS is still free at the point of use for everyone, which I believe was the object in the first place: that sick people would have access to care regardless of income. However the back-end management works, this salient fact will still be true, and there is good reason to believe that these reforms, particularly the commissioning reforms, will help to improve that care, as the people responsible for looking after these sick people will have a much better understanding of their patients’ needs, both individually and as part of a particular community, and thus be much able to direct both budget and resources where they are needed, instead of distributed evenly across the board without reference to patient and community health profiles.

  6 Responses to “Those NHS reforms…”

  1. Unfortunately this government has not appeared to have much competence so far. These changes need to be right and competently implemented if they are to improve the existing arrangements..

    • On the contrary, these changes are designed to free the NHS from central government, so that central government’s incompetence is less damaging.

      • In some ways, yes, but then I see that goal as less achievable and therefore less significant…

  2. “In the end, none of these reforms alter the vital fact that the NHS is still free at the point of use for everyone, which I believe was the object in the first place…”

    Wasn’t the point that it should be paid for at the point of use, i.e. by NI or parent’s NI? And yet, it’s ended up treating people who have never, ever ‘paid in’, and are unlikely ever to do so?

    Fix THAT first, or the rest is just rearranging deckchairs as the band plays on…

  3. Mid-Staffs Morgue is a Foundation Hospital. I gather that when assessing its application fr this status, no clinical considerations were considered, only its financial competence. Foundation status also meant that those in charge, responsible for the death of maybe 1000 patients, awarded themselves seven figure payoffs, and then left.

    Not too impressed, myself.

  4. Look it’s real simple…

    The public sector exists for the benefit of the staff and the unions. If you break it down into lots of competing units, the unions lose their power as they can’t force large scale industrial action and the workers can be held accountable.

    So its the large unresponsive blob option for them then…

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