Thursday, 2 June 2011

NHS Reforms - Good surgery cures, bad surgery kills

In the few weeks since the NHS Future Forum was launched (you remember. listen, pause, reflect, improve), Andrew Lansley has been strangely quiet.

Maybe the UK Health Secretary has been listening, pausing, reflecting and improving after all, I wondered? Maybe he’s being sidelined? However one views the planned NHS Reforms, no-one can deny that the way they have been positioned has been potentially very damaging for the Coalition. Maybe he’ll be sacked? None of the above. Instead, he has his head above the parapet, leaping out of his bunker with renewed vigour but same ammunition I’m afraid.

Writing in the Daily Telegraph today under the headline ‘Why the health service needs surgery’ Lansley writes with good sense about the challenges facing any state funded health system in this age of increased life expectancy, expensive innovations in treatment and costly drugs.

He is spot on – the NHS does need surgery. But we need good surgery not bad surgery. A bit like a plumber removing your appendix with a combine harvester – the wrong treatment for our ailing healthcare system by badly qualified operatives will do more harm than good.

In the article, Lansley quotes facts and figures regarding cost projections. Of course we need to review the fundamental way that care is delivered, quality maintained and performance measured. But I, and many others still fail to understand how the reforms laid out in the Health and Social Care Bill will achieve the cost reductions and service improvements needed.

Yet again, Lansley fails to explain how GP’s undertaking a commissioning function will save money and improve services. Millions of pounds have been paid in redundancy payments to staff from Primary Care Trusts who are already being re-employed by Consortia to fill their commissioning skills gap.

Will the extra layer of management removed by the Bill re-appear in a different guise elsewhere? Where are the safeguards against this? How will empowering patients (a worthy and indisputable goal) reduce costs? For true choice to be offered, there has to be a surplus in delivery options – simple fact. I agree that better outcomes should be cost effective – but where is the proof that any of these reforms will improve outcomes? Targets improve outcomes. Minimum performance standards improve outcomes. Innovation and ongoing training and continuous professional development improve outcomes.

I truly hope that the listen, pause, reflect and improve initiative allows for all of the above. Alas, Mr Lansley is still failing to convince me.

Surgery to fix the NHS by all means, but surgery based on experience, expertise, research, modelling and informed input.


Drmike said...

Not sure that I agree with you Marcia. I was very much at the forefront of developing GP fundholding with the Tories in the late 80s. We brought in GP Fundholding and it worked really well. GPs could buy and provide loads of servicess like Physio, pharmacy and Specialists consulting in GP premises. We also experimented with secondary care purchasing. It worked really well and patient surveys showed that they loved the new accessibilty produced by the new policies.

Labour abolished it solely because of political dogma. They brought in PCTs which is simply a rehash of Area Halth Authorities which never ever worked. I think we HAVE o return to some form of Primary care based funding and purchasing of secondary care.Patients want quality and choice and they are NOT getting this in the current system.

Andrew Lansley has spent years researching this and the ideas are not just a sudden reflex idea.

We should give hime a chance but I agree that some changes to the original bill are required.

Dr Mike Goldsmith

Finchers Consulting said...

Thanks for your comments Mike. I fear that Andrew Lansley has overcomplicated things and is handing over too many funds to GPs in too short a timescale. I do fear that the hospitals may end up with the short straw. I wish you could have been more involved with the drafting of this Bill!

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