Tuesday, 7 February 2012

NHS Reform – Is it too late for the public to take notice?

‘You’re scaring me now – can we change the subject please?’  Was this the recounting of a tale of horror – a scary film, gory story? No – it was me having dinner with a friend a year ago. She is a teacher, mother of three, with a semi-retired husband, elderly parents and a blind faith in the sustainability of the NHS to be able to care for them all. Conversation had turned to my blog and I shared my concerns about the Health and Social Care Bill. An intelligent and socially aware individual, she had until that point assumed that a radical reshape of the NHS would automatically produce a better state funded health system – until I shared some of my personal views on this flawed piece of reform.
I was reminded of this conversation reading Benedict Brogan’s excellent Daily Telegraph blog (@benedictbrogan) today where he comments ‘Mr Cameron is now opposed by the nurses and doctors in a way that the public might begin to notice’

To those of us with any inside knowledge of the NHS and how it works (or doesn’t),  the shortcomings of the Bill have haunted us daily – but the public so far have been oblivious to the realities of this top down restructure. In our press they see horror stories of inadequate care, limited resources and nightmare scenarios for hospital patients. They read of waste, poor standards and treatment rationing. Yes, most of these stories are true, but the situation is unlikely to be improved by these reforms. How can ‘the man in the street’ possibly understand what’s really going on?

Although I try to avoid politics in this blog, this coalition government has shown some weakness in a desire to please everyone. I wonder how long it will be before public opinion starts to sway Westminster on the Health Bill. Unfortunately this is where the opponents to the Bill have made their biggest mistake. The public are not impressed with strikes by NHS workers demanding that their pensions and jobs are protected in a way that those outside the public sector can only dream. Although Andrew Lansley, the UK Secretary of State has failed spectacularly in his narrative to clinicians and NHS administrators, his sound bites have, so far, persuaded the public that giving GPs the lion share of power and budget control is the way forward (even though the Royal College of Physicians do  not support this Bill).

One of the comments on posted by a wise reader of this blog states that the public are too concerned with paying their mortgages and riding the recession to be bothered with the arguments offered by the Bill’s detractors. This is where Lansley has got it right and the Bill’s opponents have missed their chance.  The Coalition is still backing the Bill. It may have a rocky ride through the Lords and the Commons but, again as Brogan writes ‘Cameron has shed too much blood to back down on health reform’.

I hope I’m wrong but I believe it is too late to muster public support.

Lansley will have his way.


Chairman Chegwin said...

I think the Bill will scrape through - just. And it will depend on Lib Dem support, just as it has in the Lords. Without the LDs it doesn't happen.

However, even if the Bill falls, reform is happening now. Many of the pieces are in place or are in the process of taking place: the Commissioning Board is set up and has the status of Special Health Authority. A Chair and Chief Executive are in place. 279 CCGs are established. The previously 152 PCTs have clustered into 50, just as 10 SHAs have become 4. Commissioning Support Units are in place. By the end of the year, the commissioning landscape will have been transformed.

For me there is a serious discussion to be had about whether all that is happening at this time is in any way constitutional without the will of Parliament behind it via Royal Assent of the enacting legislation - but can the Bill falling undo these changes? We can't just remake what was in place before so what happens to the NHS then?

Chairman Chegwin said...

And just to pick up the point about public support for GPs handling a large proportion of the NHS budget - I wonder if this is actually true?

GPs are not NHS employees - they are independent providers contracted to the NHS to provide primary care services. From what I observe, it would be stretching the point to say that all GPs have an in-depth understanding of all their patients' medical needs, since few of them spend any more than 5 or 10 minutes per appointment. And who gets to see a named or list-assigned doctor these days? The majority of doctors at my local practice are locums. As GPs form ever larger practices, their knowledge of individual patients will become even more reduced it seems to me?

So I do question the wisdom of placing such a reliance on this group of healthcare proessionals.

Finchers Consulting said...

I don't understand why a health bill has been tabled at all because, as you say, reforms are already happening which I find very confusing. I agree with you that the weakest link is the GP. Standards of service (not care, service) have been reduced through the years. Who remembers the days when your GP would take turns to provide out of hours coverage?As you say, most of them neither have the will, nor ability to commission services. As the HSJ, BMJ and Nursing Times say - it's an unholy mess and I find it incredible that Lansley has survived.

Chairman Chegwin said...

I think what's happening is happening because of the White Paper and the Bill - the NHS couldn't afford to stand still with the timetable the Coalition imposed. Doesn't mean it's right, of course.....but it IS unconstitutional.

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