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Zircadian Director Masood Ahmed reflects on the government's reforms of the health service.

 

"Modernising the NHS is a necessity, not an option, in order to meet rising need in the future we need to make changes." – Andrew Lansley

 

The NHS white paper ‘Liberating the NHS’ was released in July 2010 and paved the way for the biggest reforms to the NHS since its inception in 1948. The Health & Social Bill is a brave step (or should it be leap of faith?) which will give most of the responsibility for NHS budgets to our GPs. This 350 page blueprint lays out how £80 billion will be handed over to our GPs. That can’t be bad; after all they are a caring group that have patient interests at heart. Therein lays the problem, just because they know about you and me, and our healthcare needs, who is to say they are in the best position to determine the budgets for our hospitals? No one is really sure how this will pan out, but it does seem that Andrew Lansley will either be viewed as a visionary and the saviour of the NHS or as the man responsible for its downfall.

 

So, what next? The reforms aim to ...

 

Give control of NHS services to frontline doctors and nurses. This means all Primary Care Trusts (151) and Strategic Health Authorities will be abolished by 2013.

 

Get local decisions made by local people. GPs will form consortia and will be responsible for buying and planning local services, e.g. hospitals, GPs, mental health and community clinics. They will also have the power to prevent the closure of local services such as A&E and maternity services.

 

Cut managers, waste and bureaucracy. Over 20,000 managers will be made redundant with an average payout of £48,000. This adds up to a redundancy bill of £1 billion, but should result in savings of £1.7 billion a year.

 

Give the NHS democratic legitimacy by creating Health & Wellbeing Boards that will drive the integration of health and social care.
Increase competition by getting the NHS focused on the results it delivers for patients. Services can be provided from both the public and private sector, and the increased competition will lead to better care and value for money.

 

Is this revolutionary or evolutionary?

 

Not really a new idea, just on a bigger scale than ever before. In the nineties, the Tories introduced GP fundholding. Then Labour introduced practice based commissioning, but this was limited to specific areas of care, e.g. knee operations. The Coalition have gone the whole hog and given GPs a cool £80 billion to play with. But this only applies to
England, as in the devolved nations there will still be a national approach to healthcare.

 

What are the risks?

 

There have been significant concerns raised throughout the profession and by those that hold the NHS close to their heart. Can the speed of the reforms be justified? This will be a new ball game for the inexperienced GP consortia and about 500 GP consortia will manage 80% of the NHS budget by April 2013, and even though PCTs and SHAs will be abolished, 60% of staff will be retained in order to support the commissioning process. Many will ask that if we are keeping such a high proportion of staff, why not simply scale back the current PCT and SHA structures. Under the reforms hospitals will need to gain foundation status and will be free of central control. Two thirds have already achieved this, but not without problems when balancing the books. And these problems are likely to be magnified as the reforms create a more competitive market. Trusts rely on certain services for income, but with the market opening up to the private sector, there are concerns that private firms will cherry-pick the profitable, low risk procedures, e.g. cataract operations, and trusts will suffer as they have no choice but to provide other essential services.

Have we asked GPs to deliver on a plan that is so ambitious and radical that the consortia have as much chance of achieving their goal as England has of winning the World Cup? It looks good on paper but could the reality of the task be too much, even for our wonderful GPs? And what about the timing? – we want to reform the NHS with consortia that have no track record, saving £20 billion from the NHS budget, and get it done within 3 years. Who knows what will happen? But I’m a supporter of the NHS, an England fan and an eternal optimist.

 

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