Response to the NHS Future Forum: A wide range of emotions...

‘The House of Commons will vote on a motion to recommit the Health and Social Care Bill to a public bill committee for further consideration on 21 June 2011.’ This was the helpful missive I received today as a subscriber to UK Parliament updates.

Andrew Lansley, UK Secretary of Sate for Health, will hope that his reformed reforms are back on track, ready to be ushered through parliament towards the House of Lords.

I have now had a chance to review the proposed changes and as usual, am experiencing a wide range of emotions.

Satisfaction: That the government has listened and appreciated the strength of opposition to the content of the original Bill. David Cameron has realised that taking his eye of this particular ball was potentially highly damaging for not only the NHS but for the Coalition too. It is also gratifying to see that the listening exercise appears to have produced a genuine change of direction in emphasis and execution of the Bill.

Encouragement: That some of the key areas of dispute have been addressed. Despite Lansley’s insistence that all-encompassing power should be handed to GPs, there is now an understanding that this is not the view of the majority of stakeholders and indeed is not the choice of many GPs either. Interesting to note that when I first started this blog last year, the original spend to be handed to GPs was £80 billion annually. That quickly but quietly changed to £60 billion and is continuing to shrink. I am delighted to see that ongoing professional development is acknowledged as key. I also agree with the proposed change in the role of Monitor, the regulatory body, with regard to managing competitor activity, ‘protecting and promoting patients’ interests’.

Confusion: That there is still no explanation of how these reforms will actually deliver better, more cost effective care. The challenge the government has tasked the NHS is a reduction in costs, year on year of 4% for the next 4 years. How are these changes going to save money? The staged introduction of Clinical Commissioning groups is a little woolly, ‘Where a group is not ready, the local arms of the NHS Commissioning Board will commission on its behalf’ This begs the question – why not let the local Commissioning Board do the commissioning - full stop?

Concern: How will the damage caused by extended timescales and slow painful death of Primary Care Trusts and Strategic Health Authorities be mitigated? The loss of experience and intellectual property could be massive. An estimated £772 million will be spent on redundancy payments and I have seen first hand that it is the most able and re-employable that are accepting this way out. It is expected that many will be re-employed by the commissioning consortia. Indeed, in Lansley’s proposed changes to the Bill he states that the NHS needs to ‘ ensure that high quality management is valued across the NHS with a commitment to retaining the best talent across the PCTs and SHAs’ Oops! In panicky response to the original timescales, many of these people have headed for the hills, with a nice fat cheque in their back pocket.

Frustration: That this fiasco could have been avoided with more thought and consultation in the first place and major restructure of the NHS was not in the original political manifesto. There is still no evidence that although it is universally agreed that quality and efficiency improvements are essential for the NHS, top-down, bottom-up or middle-out restructure, whichever way you look at it, is not necessary or even desirable to achieve these improvements. Improved culture, refined practices, better management and robust quality assurance could deliver the required results.

And finally….

Hope: That somehow the intelligent and committed clinicians, patient groups, administrators and interested parties will interpret these reforms in an inventive, workable and practical manner to achieve the worthy aims of this troubled piece of legislation.