Originally published @ 2:10 pm, Tue 4th Jan 2011
Further to the outrage of only being able to meet election pledges on NHS spending by including some monies allocated to councils, the NHS re-organisation looks set to cause immediate problems because it takes away the focus and capacity from the efficiency drive that was already built into the NHS budgets, as well as longer term problems, with the removals of Primary Care Trusts.
But now concerns are developing about the threat from private health suppliers. Polly Toynbee writes “For the first time the entire NHS has been put under competition law. The financial and clinical safety of NHS foundation trusts used to be the responsibility of the regulator, Monitor. Now its website proclaims: "The first of Monitor's three core functions is to promote competition." That means "enforcing competition law" and "removing anti-competitive behaviour".”
Last week, a Tory MP wrote “I know many GPs who are keen to tackle the redesign of care and even the issue of failing colleagues, but I know none that are interested in EU competition law. If commissioners cannot design care pathways free from the spectre of lawsuits from private providers, they will hand over to commercial commissioners prepared to take the rap.”
The ambition to provide a minimum and timely standard of good service has been lost and now the NHS faces choas.
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When the proposals for reform of the NHS was first announced, some colleagues said “they’re trying to privatise the NHS!”
But of course, the NHS has never been a purely public provider. Very difficult to draw such a line in any service, cos like others the NHS contracts GPs for medical services, firms to supply goods and buildings and so on. What is distinctive about the NHS is that it is free at the point of use (and so serves all irrespective of wealth or income and avoids a huge burden of insurance administration) and is an expression of Britain being better when the British act together. The ConDem’s proposals don’t directly threaten these principles.
However, to validate its distinctiveness, such free services have to be provided with quality and timeliness. Threaten these and the principle of the NHS is threatened. It’s why Labour argued 24 hours to save the NHS in 1997. Too many people felt the need to go private because waiting times were too long. (Some talk about the waiting list, but there will always be a list.) So Labour trebled the cash spent in its 13 years and started the biggest hospital building programme the country had ever seen.
The outcomes were guarantees in terms of time between GP diagnosis / reference and operations, waiting times down to a maximum of 18 weeks across the country and a significant increase in the average life expectancy of British people (10 years, I think).
Challenges remained – - drives to keep infections acquired in hospitals down, - a more elderly population requiring more services, - drugs and new technology seemingly perceived as increasing costs (although I suspect this is more about increasing the potential to do more good), - inconsistency in quality across the NHS (with some big problems such as occurred in Stafford), - employing more managers to maximise the ability of health workers to provide the services (not well received), - dealing with the fallout of so many re-organisations; - appearing to be overbearing cos of the drive down on smoking and drinking, - seeking still better cross-agency working to put the needs of the user first, and - care for the elderly being outside the NHS causing something akin to a lottery as to your financial welfare in old age.
Despite these challenges, defence of the NHS became such a premium because of the progress made, even though people’s memories of the problems of the eighties and nineties were starting to dim. Hence the Conservatives sought to outbid Labour by promising no cuts for the NHS, something Labour would not match (I imagine) because of an expectation that since the NHS was such a large part of public expenditure, that it would have to take a share of any general reduction in public finances. Even with my short time on a health scrutiny committee you could see that some parts had been able to re-organise with a good effect on both services and costs; and some parts of the service clearly had some way to go. Obvious too that the NHS was not sufficiently accountable to local people.
So, a lot done, still more to do; and the ambition was there.
Now, the minimum targets have gone, and along with it the focus required to do more for the more challenged areas.
The financial pledge made by the Conservatives is only being met by counting some monies allocated to councils.
And the drive on efficiency is being lost through a re-organisation.
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