Sunday, 24 October 2010

NHS Update

When I started this blog a few weeks ago, I intended to comment on all aspects of healthcare in the US and UK, and so far I have avoided the £105 billion question – the National Health Service. So this week I shall concentrate my postings on a summary of my interpretation of what’s going on with the organisation that is cared for us in the UK from the ‘cradle to the grave’ since 1948.

The NHS was developed on the basis that good healthcare should be available to all, and it was based on three core principles:

·         That it meets the needs of everyone
·         That it be free at the point of delivery
·         That it be based on clinical need, not ability to pay

These principles still hold, but the way that healthcare is delivered and responsibilities and accountabilities are shifting.

In July 2010, the coalition government announced its vision for change for the NHS in a paper entitled: ‘Equity and Excellence – Liberating the NHS’. This paper instigates a period of significant change and represents one of the most far-reaching re-structuring since the NHS was founded.

The NHS is tasked with finding £20 billion in cost savings while maintaining quality and range of services. The focus will be on ‘outcomes’ rather than ‘targets’ and the Health Secretary promises improved survival rates and leaner administration. The document outlines the plans for the government to give general practitioners (GPs) more power and responsibility for holding budgets and commissioning healthcare with the aim of aligning services more closely to patients needs. The key points are:

·         £80 billion budget to commission community, hospital and mental health services will move to the hands of GPs. The NHS budget stands at £105 billion and 80% of this will be given to GP commissioners.
·         Spending will be controlled by GP consortia who will be accountable to patients for the services they commission. The deadline for full financial responsibility of GP consortia is 2013.
·         An independent NHS board will be set up to oversee the commissioning of services
·         Independent providers such as consultants and private organisations will be invited to provide services to the NHS if their services are of a ‘high quality and meet NHS requirements.’
·         All NHS Trusts will become Foundation Trusts by 2013, providing greater autonomy.
·         The private income cap will be removed from Foundation Trusts, giving them opportunities to expand the services they offer to patients.
·         Process targets will be abolished and payment will be ‘by results’.
·         Monitor, the foundation trust regulator, will be given new powers, to regulate prices, promote competition and ensure that all providers generate efficient and financially sustainable services.
·         Management costs in the NHS will be reduced by 45% over the next 4 years, ‘cutting £1 billion in bureaucracy per year’.

These proposals are being discussed through a public consultation process and the impact of this consultation period will be discussed in my next posting. I shall also discuss my view on the planned shift of power to the GPs.

It was very easy to question the clarity of the U.S. Healthcare Reform Act, but let us not forget that changes closer to home are causing just as much anxiety and confusion.


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