Is the NHS reform bill a cure for Britain’s healthcare ills?
YES
DAVID SKELTON
ANY changes to the NHS are always going to provoke controversy. But in a healthcare landscape characterised by changing health needs, rapid technological innovation and rising patient expectations, reform is vital if the NHS is to meet the challenges of the coming decades.
That is one of the reasons that these proposals are following in the footsteps of reforms put forward by every health secretary since Ken Clarke, with the sole exception of Frank Dobson. Each reform has been opposed with the same zeal by most of the opponents of the government’s Bill.
The British Medical Association (BMA), for example, has opposed most pieces of health reform since the war, including the formation of the NHS. It seems perverse that the BMA has made such a stink about non-attendance at a meeting about the implementation of a reform they oppose. It’s a little like a Manchester United fan complaining about non-invitation to a meeting about the future of Manchester City.
There’s good policy sense behind the devolving of power from managers in Primary Care Trusts to local GP consortia. In essence, the reforms involve transferring power from managers to doctors and nurses. Giving GPs more power over commissioning empowers clinicians, who understand patient needs and health needs and are in direct contact with patients, rather than relying on remote bureaucrats.
Moving commissioning power to the front line, putting the power in the hands of the health professionals who see patients regularly can only strengthen the NHS, with changes to commissioning helping to put the patient at the heart of the process. It will also help to align clinical decisions and their financial consequences.
That decisions about local healthcare should be made by local doctors, rather than administrators, in no way resembles the revolutionary change that many warn about. In many ways, it is a continuation of the Tony Blair/Alan Milburn reforms. There’s compelling evidence from those experiments with practice based commissioning that GP commissioning can deliver better quality care for patients, while avoiding unnecessary and expensive hospital admissions.
Opponents of reform also object to competition and contestability. That is dogma over-riding both experience and practical necessity. The private sector and the third sector clearly have an important role to play in delivering innovative and cost effective services to the NHS. Competition and contestability will increase the choice available to patients and to commissioners and enhance the service provided to patients.
Surely readers of City A.M. do not need to be persuaded that competition and contestability, rather than monopoly provision, is a good thing that will improve patient outcomes. In opposing the role of private and third sector providers playing a role in the NHS, opponents of health reforms are opposing the policies of the last government as much as they are opposing the policies of this government.
The NHS cannot be preserved in aspic if it is to meet the needs of 2012, which are very different to the needs of 1948. People are living for longer, the cost of care is rising and patients also have higher expectations than ever before.
NHS reforms are necessary to ensure that it continues to prosper in a fast-changing environment. Vested interests should not be able to wield a veto. Just as the NHS evolved in the past, it needs to continue to evolve so it can continue to deliver first class services that put the patient at the heart of the process.
David Skelton is deputy director of the independent think tank Policy Exchange. You can follow him on Twitter @djskelton
NO
DR PETER CARTER
WHEN talking politics, I’m always reluctant to use medical analogies; it can seem rather predictable from someone who works for an organisation like the Royal College of Nursing (RCN). However, when talking about the government’s Health and Social Care Bill, the dramatic blueprint to reform the NHS, the analogies seem more apt. Put simply, the Prime Minister’s diagnosis is correct but the treatment is very wrong indeed.
The government is right when it says that the NHS needs to change. Of course it does. Our population is growing, it’s getting older and more of us than ever before are living with medical conditions that last decades. The way we look after patients now, with a focus on hospital care, just won’t work. We’ll need to move care into our communities and, in some cases, our homes. The NHS does need change. It needs to evolve with the times. But it does not need this bill.
Only last month, the RCN – which represents 420,000 nursing staff in the UK – moved to oppose the bill and we’re now calling for it to be withdrawn. Why? Because not only does it fail to fix the problems posed by our changing health needs, but it also stands to do real damage to our healthcare system and the patients that use it.
Take the role of competition, which the government wants to increase dramatically in the “new NHS”. The RCN does not oppose competition in principle; competition has been part of the NHS since it was founded in 1948. The problem lies with just how much competition the government wants to inject into the NHS. The more that services are told to compete with each other, the less joined-up a patient’s experience will be. The newly-diagnosed cancer patient doesn’t want health providers that compete with one another, but services that cooperate and share information.
The bill also spells out changes to the private patient income cap, which is the limit to the number of private patients that any organisation can treat. The government wants to raise the cap to 49 per cent, considerably higher than it is now. Whilst this may seem like a technical change, the effect on patients could be very real indeed. If NHS organisations shift their focus away from delivering good care and finding savings that don’t impact on the frontline, and instead concentrate on how to cater for the private patient market, NHS patients may suffer.
The RCN has sought to engage with the bill at every stage. We’ve consulted with our members, we’ve outlined our main concerns, we’ve given evidence to parliamentary committees and we’ve even hosted “listening exercises” with Andrew Lansley. It was after a year of working constructively with the government, and not seeing the changes that we were asking for, that we felt we had to move to oppose this bill. Put simply, the turmoil of continuing with this bill is now much greater than the turmoil of stopping it. The government may have dismissed our concerns as “vested interests”, but our only vested interest is making sure that the NHS delivers for patients everywhere.
This bill is contentious for a reason. When a list of opposing organisations includes the RCN, the British Medical Association, the Royal College of General Practitioners, and many others, you have to question whether you’re doing the right thing. We want the NHS to evolve, we understand the need for change, but this bill is the wrong way of doing it and doctors, nurses and, most importantly, patients will suffer.
Dr Peter Carter is the chief executive and general secretary of the Royal College of Nursing.