The health secretary put up a robust defence of his proposed NHS reforms at the Conservative Party Conference this week.
Far from being daunted by growing union unease, Andrew Lansley re-stated his commitment to giving GPs responsibility for commissioning “because family doctors see patients every day, they know where services are failing and they will fight for best care possible for their patients”.
Of course that’s not the bit the BMA are worried about. Anything that puts doctors in the driving seat is worth exploring and that’s the position the union has adopted.
Nope, they’re worried about the bits that herald the mass privatisation of the NHS and rightly so.
Equity and Excellence: Liberating the NHS proposes that GPs should control 80% of all NHS spending and commission services for patients from 2013.
Patients will have a choice of doctor and receive treatment from a range of providers that meet NHS standards and cost the same or less. It includes social enterprises, charitable organisations, public providers and the private sector (although it’s always called the independent sector in ministerial speeches).
Lansley told the conference that patients would have “the right to choose where to be treated by any provider, in what will become the largest social enterprise in the world”.
I’m fairly agnostic over use of the private sector. In social care, for example, there are plenty of examples of private and third sector providers who perform well in a severely underfunded environment.
However, I don’t buy this idea that competition holds all the solutions. There might be a role for the private sector in certain situations, where the public sector has demonstrated an ongoing inability to deliver, such as with Hinchingbrooke Hospital, but we need to see the evidence.
Healthcare delivery is more complex than social care, and if private sector providers are going to compete for ‘business’ then it has to be on a level playing field with equal tariffs, the same case mixes and all the costs of running medical teams included.
This week a report by Civitas looks at why commissioning isn’t working and suggests there needs to be more incentives to encourage innovation. Part of problem, it claims, is that the NHS has a closed shop mentality which stops it working well with private health providers.
The report’s author, James Gubb, said: “The coalition government has put a lot of faith in the power of the market to meet the NHS’s unnerving productivity challenge.
“The problem is the coalition isn’t addressing the real issues as to why the market currently isn’t delivering: the overwhelming power of hospitals and the closed-shop ‘we can do it alone because we’re the NHS’ attitude so prevalent across the organisation.”
Well, what do you expect following Labour’s ISTC programme where private providers cherry picked their patients, sought to compete rather than integrate with local services and obfuscated their costs and outcomes.
Within this brave new world all trusts are to become foundation trusts, run as social enterprises, and their regulator Monitor is being given specific power to encourage competition. Are they ready to be foundation trusts? We’ve all seen what happens when the priorities get skewed. And what chance do the national terms and conditions of the staff have of surviving? Local pay negotiation will be a nightmare for all concerned.
Putting my ideological reservations to one side, there are also practical ones.
Just a few months ago Lansley was decrying top-down, centralised change programmes. Then he got into office and initiated the mother of them all.
Is it affordable during these tough times? Why can’t GP consortia be piloted before roll-out? And, why is everything being done at a break neck speed?
Slightly worryingly I find myself agreeing with Andy Burnham, that the white paper should be a green paper with a longer piloting and transition period. (Again there was a certain irony in hearing his views on the reforms at the Labour Party Conference: “They are an attack on the N in NHS - a frightening vision of a fragmented health service, where markets rule, competition trumps cooperation, private sector giants outbid the NHS and profits trump patients.” Er, Andy, you started it…)
With Unison seeking a judicial review of the white paper’s implementation and doctors’ representatives damning it with faint praise, bravado alone will not be sufficient to get Equity and Excellence: Liberating the NHS implemented in its current, pristine condition. Principles may survive but the detail will be softened.
Tags: Health policy, Privatisation
Presumably the rush is because the Tories want everyone to see ‘the benefits’ in time for the next election, which will be as closely fought as the last.
Unfortunately, that means more disruption for us - I can’t see it being that easy for GPs to take on all the PCT roles without a considerable expansion in capacity, and who’s going to fund that.
I agree with Mark II in that Lansley wants the changes done as soon as possible with an eye to the next election. I note his use of quotes around “benefits” because, I do not think that there will be any, neither for doctors nor for patients.
The White Paper should be called “liberating the government from the NHS” because the intention is for Lansley to be able to say “I am merely the SoS for Public Health: primary care and secondary care are nothing to do with me at all - they are ALL independent providers”. He has calculated that it will take a couple of years of Andy Coulson feeding the Press with stories that the government has nothing to do with providing healthcare to get the public to stop thinking that the Secretary of State of Health has anything to do with healthcare provision.
Of course, the result is that Doctors will take the blame for everything, including the rationing that will come about from the heavy cuts that we all know will fall on the NHS, but we were told would not happen so that Lansley could get his way. And that’s why Doctors muct oppose the white paper. Anyway, it should be doctors drawing up the plans for the NHS not a mere politician, right?