Monday, 14 March 2011

Is it just Spring or is there a sniff of U turn in the air?

So far, Andrew Lansley, the UK Secretary of State for Health, has been resolute in his determination for forge through the NHS reforms, giving control for 80% of the annual budget to general practitioners. He has appeared to suffer from an unusual form of selective deafness and maybe some word blindness too, by ignoring the verbal and written concerns by those in the know.

Earlier this year, in an unprecedented move, eight highly respected and knowledgeable leaders from organisations such as the British Medical Association (BMA), and the Royal College of Nursing wrote to The Times criticising the speed and scale of restructure using language such as ‘potentially disastrous’ and ‘extremely risky’. This, and many other pleas to reconsider have been ignored and as the weeks and months have passed, the momentum of criticism of the health bill has grown.

Lansley faces a vote of no confidence at a special representatives meeting of the BMA this week and now six major health bodies have rejected the government’s new voluntary ‘responsibility deal’ on alcohol. Organisations such as Alcohol Concern and The Royal College of Physicians say they were ‘brought to the table too late’ and that there needs to be a clear strategy on alcohol to replace the ‘lack of clarity’ with the recent initiative. Still, we get the feeling that these voices, growing in crescendo, will continue to go unheeded.

But now we have the Liberal Democrats, at their Spring Conference, voting overwhelmingly to pass a motion criticising the reform proposals. Finally, words are being spoken in a tongue that the government understands. No interpreter needed. The language of politics. But is this going to be too little too late?

GP’s and primary care providers HAVE embraced this change – some because they felt that they have no choice. Yes, some are enthusiastic and gearing up for the major change. Why wouldn’t a group of people given the opportunity to increase their influence and income be keen to give it a go? But secondary care and the hospital trusts are still in real danger of being disenfranchised.

And my point is? Now that it could be politically desirable, Lansley may have to reconsider some of his plans. But the wheels are already in motion – to try to unravel the changes so far could be even more damaging than allowing them to continue.

I am put in mind of the time I tried to teach my daughter to drive. I wasn’t very good at it and at one point we approached some traffic lights just as they were turning red. I wasn’t at all helpful and told her to stop too late, by which time we were in the middle of a busy junction – with the car blocking oncoming traffic as it started to approach. I wasn’t sure what would be best - to tell her to reverse and go back to where we were or to put her foot on the accelerator and try to speed our way out of trouble. I continued to dither and opted for neither and chaos ensued. She had told me that I needed to change my approach on instruction and I hadn’t listened. (Needless to say, after that episode all lessons were undertaken by an expert)

My advice to Andrew Lansley? Listen. Don’t just listen to GPs, listen to all interested parties. Then make a decision, stick to it and find a way to adapt your reforms to encompass what you hear. Give us some clarity on how commissioning will work. Reassure us with concrete direction to ensure that hospitals and secondary care will be protected and innovation nurtured. And then maybe, just maybe, you will start to like what you hear.

Today, the Prime Minister’s spokesman said ‘There are not about to be significant changes to the policy’ but then added that MPs and peers would have the chance to debate and ‘if necessary’ amend the Health Bill

If there is any type of U turn, we need a clear strategy, supported by those all along the patient pathway, with definitive plans and not just platitudes and soundbites.



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