Thursday, 8 September 2011

What next for the NHS? Oh for a magic pill.

Regular readers of this blog will know that I occasionally list the good, the bad and the ugly, when taking a snapshot of the NHS.

Alas, today I am struggling to find the good but can easily identify the bad and the ugly when it comes to the current state of affairs as we face more uncertainty.
I try not to scare-monger and still hope that some sense will come out of the Health and Social Care Bill, but I am further disheartened by the reports from yesterday proceedings in parliament. Andrew Lansley, UK Secretary of State and the Prime Minister are sticking to their guns that there is significant support for the reforms. Even though the Royal College of Nursing, The British Medical Association and the Royal College of GPs have all issued statements reiterating their concerns over the reforms, the government health team believe that the ‘listening exercise’ means everyone is now on board. Why is it that they seemed to hear something very different from everyone else?

Lord Howe, health minister exacerbated discontent by stating that it ‘mattered not one jot’ who provided NHS care.

There seems to be a reality gap here. Those of us actively involved with the NHS, either as a clinician, manager or patient all agree that changes were needed. Cost containment and service improvement are vital. But many people are now working in a state of suspended animation – decisions are being delayed until the way forward is clarified. Meanwhile Hospitals and PCTs are cutting resources, mainly staff, in response to budget demands. GP consortia – oops, sorry – the amended Bill now refers to Clinical Commissioning Groups - are nervous of investing in infrastructure for their new roles  until the Bill passes through the House of Lords – and there is no guarantee that it will emerge unscathed from its next stage.

So as far as I can see, urgent treatment is needed.

Firstly – some ear drops for Andrew Lansley and Co. to improve listening ability and maybe a special medicine that increases comprehension of the facts laid before them.

And secondly – a magic pill to release the creeping paralysis that is slowly, but surely strangling the NHS.


Chairman Chegwin said...

This has gone beyond what is good or bad for the NHS - no one really knows anymore because the narrative isn't there for anyone to take a proper position on.

It's now about demonstrating the strength of the Coalition in seeing business through.

Finchers Consulting said...

I agree. It's the indecision and protracted passage of the Bill that's causing the harm. The narrative is indeed difficult to comment on - like a wil o' the wisp!

Chairman Chegwin said...

That process is about to get even more protracted in the Lords, who will scrutinise it with their usual forensic precision. But even then they probably do not have the political capital or mandate to kill it.

While the Government, in my view, has not set out the narrative that tells us the particular set of problems that the reforms seek to solve, the opponents of the Bill have themselves not set out a compelling case as to why reform is not necessary. The breathless indignation about "privatisation", "competition law", "credit card healthcare", "American system" etc etc is not only innacurate, it ignores the fact that PCTs and SHAs have largely failed, squandering unprecedented amounts of additional money in the process.

The BMA are particularly confused - they do not want "privatisation" of services yet ignore the fact that GPs operate independently and seek to protect that right.

I don't pretend to know the answer(s) but I do believe that plurality of provision is a good thing, that standards need to rise across the board, and that we need to stop wasting money.

However, I also believe that the NHS is completely unsustainable in its current form - at some point in the future we will have to abandon this romantic (and entirely innacurate) notion that NHS services are "free". They are not - it is us taxpayers that foot the bill.

If we are to avoid even more widespread rationing and restrictions on services, we need to accept that a personal contribution will be necessary - which is why I support itemisation and individual costing of services received. People need to see the true cost of things - then they may be more critical of the waste that goes on and more demanding of change....

Finchers Consulting said...

This is an excellent summary from Chairman Chegwin. I also agree with plurality of provision and don't have an issue with private providers, as long as cost effective high quality care is offered. I also agree with your point about the Bill's detractors - easy for the BMA, RCN (and commentatoros such as me)etc to criticise the Bill but no-one has really come up with a suitale alternative. I feel thgat it is too late to go back to the drawing board - applaud the changes following the listening exercise such as including more hospital based clinicians in the commissioning process and let's get on with making this work.
The coalition have done an appalling PR job on the whole sorry affair and need to sharpen up their act in selling the proposition and explaingin exactly how it could work. In the mean time - there is still that feeling of Rome burning while some fiddling is going on...

Chairman Chegwin said...

Paul Corrigan also comments on the BMA's continuing confusion....

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