We are still only a few weeks into the coalition, and yet so much has been done. Some may laud the coalition for their swift action; however we should also be afraid of the terrible speed at which the government is bringing forward their policies.
This week the Health Secretary, Andrew Lansley, introduced the government White Paper on the health service. Equity and excellence: Liberating the NHS is a near 60 page long document setting out the changes the coalition wants to make to the NHS, as well as some unbearably sloppy language which tries to convince the reader how much the government cares etc.. I skipped this part, no one needs to be told how much the Tories care about the NHS, we know exactly how they feel. Moreover, when I read the important parts of the White Paper, it becomes clear to all that the same old Tory thinking on the NHS is still alive and kicking.
Let me start in my analysis of the White Paper where the White Paper starts with the NHS, by praising it. It is one of the most loved institutions this country has. A Health Service which cares for all, is paid for through general taxation, and is free at the point of use. It provides the people of Britain, and indeed visitors to the UK with the same service, a service that we would struggle to find elsewhere in the world, and one that we are lost without. There has been plenty of criticism of the NHS recently, mainly from conservatives in the US, (and here, thank you Daniel Hannan), following US Health Care Reform promised by President Obama. Because of this, and also because of the global financial crisis and the need to reduce the deficit, we have also seen an extraordinary defense of our National Health Service, and rightly so.
I have used it, as have many others, and so can appreciate it in ways that those who have not, cannot. Many in this country view the health insurance system prevalent in the US, and other countries, with horror. Fortunately, they think quietly, we have our NHS. But, and I hate to be alarmist, that maybe on shaky ground. The White Paper purports to merely cut waste and bureaucracy from the system. But look slightly closer, and it becomes more and more concerning. Privatisation springs to mind immediately, and it worries me.
The document promises that the government will make the NHS accountable to patients, get rid of bureaucracy, and increase spending in real terms year on year. It can't only be me who doesn’t believe this at first glance from this government. Patients will also be in charge of decisions about their care, via a new pledge No decision about me, without me. Lovely little rhyme there, that should make us all feel better. It simply takes ‘the customer is always right’ to a new level. As a customer I will admit freely now, I am not always right, especially when it comes to making medical decisions, and the best way I should be treated. I doubt that this will actually happen. Doctors will make the decision, but now we have a lovely new rhyming policy to make us all feel more involved, which is nice, isn’t it?
The government also promised to abolish targets. Let me be clear. This is a mistake. Getting rid of the A&E four hour waiting time is madness, and will take us back to the days when patients waited on trolleys for hours, and days to be see a doctor or be treated. Instead, the government will assess the NHS by looking at improvement of survival rates from cancer and strokes etc. (sound like reaching for targets to you?). It may also be worth reminding the government, that while, yes, England has one of the lowest five-year survival rates in Europe, according to the office of national statistics, survival has actually improved in the last decade from the decade before. (see here)
“Customers” will also be able to rate their surgery, or the hospital department they have been in, depending on how satisfied they are with their service, with more choice about who cares for them, which doctors, and where. Are we supposed to accept that all this will save money? HealthWatch will be established, a new agency (yes, they did say they were going to cut them), it will take on the work the Care Quality Commission currently does in regulating and inspecting hospitals. CQC will remain in place (so now there is two NDPB's where before there was one) it will simply be less useful. Keep an eye out; there are plenty of examples for these foolishly hypocritical moves.
These plans will apparently save £20 Billion in ‘efficiencies’ by 2014. They will also reduce management costs by the staggering figure of 45%. Even they can’t believe that, surely. They will ‘radically’ (yes, a conservative white paper uses the word ‘radically’) reduce the Department of Health’s own functions, and abolish Quango’s, such as the Food Standards Agency (FSA) and the Medicine and Healthcare Regulatory Association (MHRA). I’ve been told they are making worrying noises about NICE ( The national institute for health and clinical excellence, which is mentioned numerous times in the document). Vaccination and screening services have also been yanked away from the Health Service, to be incorporated into a new Public Health Service which will be legislated for soon.
In the biggest change to the current system, Primary Care Trusts and Strategic Health Authorities are to be abolished. Before, the Department of Health would fund PCT's directly, while SHA's had the job of managing and monitoring healthcare and PCT's within their area. Primary care included GP Practices, Walk-in centres, dentists and ophthalmic services. While Secondary care encompasses Ambulance trusts, Emergency care, NHS, Mental health and Care trusts. Not any more. To satisfy Liberal Democrats who wanted elections to PCT’s to make them more democratic, some powers are to be transferred to local authorities, a paltry gesture designed to save face more than anything. Other powers will go to a new Director or Public Health, working within the remit of the Public Health Service mentioned above, who will manage NHS budgets. A new commission will be appointed (yes, another one, we haven’t got enough) to assess long term care funding. It will report within a year, possibly suggesting an end to state funding and the start of a voluntary insurance scheme.
I won’t need to remind anyone that PCT’s and SHA’s were set up after full consultation. But what will replace the PCT’s and 28 SHA’s when they are abolished? Well, we all know about the new GP consortia, a new plan which has come from little or no consultation. It’s a brilliant idea (can you sense my sarcasm?). It gives healthcare professionals, who struggle to run a practice on their own especially where I live, management and financial responsibilities. As if they haven’t got enough to do? Here’s how it will work. Follow closely, or I’ll lose you in the maze. New GP consortia, bands of GP practices, will now commission a great deal NHS services for patients. They will not, however, commission the services GP’s themselves provide, rather tell hospitals what to do. They will not commission dental, pharmacy or ophthalmic services. This will be done instead by a new NHS Commissioning Board (yes, new, again, replacing a perfectly good old). In news last night (13th July) two soon to be ex-heads of SHA’s have been poached by the Health Secretary. The Head of the North East SHA, Iain Dalton, and his counterpart at the West Midlands SHA, Dame Barbara Hakin, will be given cushy new jobs at the heart of the department’s policy, retaining their £200,000 per year salary. (See here) So much for new politics and getting rid of top heavy, large salaried management...
In other funding news, the document says that the government will increase NHS funding in real terms year on year. But, contrastingly, also says, and I quote, “In the next five years the NHS will only be able to increase quality of care by implementing best practice and increasing productivity”. I could almost add ‘because you won’t be getting any help from us’ to that, and shockingly, I wouldn’t be joking. The NHS will have to make massive efficiencies to deal with the huge cuts it will suffer.
The new system means that Parliament will have to approve money to the Department of Health, which will in turn then give it to the Commissioning Board, Monitor and the Care Quality Commission. The Commissioning Board will then give money to GP consortia, who will acquire services from providers, and local authorities, which will fund HealthWatch. Accountability will go in the opposite direction. But this new complicated system means that Andrew Lansley has rid himself of any blame if anything goes wrong, and if something does go wrong, it has happened so far from Parliament that regulating it is near impossible! The job not made any easier by the assertion that “All health and social care regulation will be reviewed and reduced”. And what happens if the consortia don’t work and funding is made a mess of? Nothing. The government will wash its hands and walk away. It has refused to bail out any failed group; instead, Monitor will be given that responsibility.
To cap it all, hospitals have been asked to make up 25% of their own funding by taking on increased private work to mirror that of the Royal Marsden in Kensington. What the Tories have failed to realise is that Kensington, London is not Walton or Fazakerley, in Liverpool, or even Hull, and cities like this cannot be expected to meet this expectation. (See here)
In conclusion, these health changes are not simply a cost cutting exercise. They are not even aimed at improving the health care the NHS can provide, but simply a new way of deconstructing the normal cohesion of the NHS, breaking it down into small blocks, giving the private sector more influence and opportunity, at the cost of reducing the role of the public sector massively. As this article in the Guardian says, the most critical risk of this White Paper is that the NHS won’t survive the shock of what many see an appalling, ideological, dogmatic ambush on the NHS
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