After promising not to tinker with the NHS’s structure, Andrew Lansley has gone back on his word. On top of his broken promise, the proposed reorganisation will be an immediate financial cost to the NHS, not a saving. It is difficult to quantify the economic cost of low staff morale but this will undoubtedly be another cost. And there is no evidence that this reorganisation will deliver more efficient and effective healthcare making savings in the future. Another coalition fallacy is that the NHS is being protected from cuts. Ask any NHS worker whether this is the case and the answer is loud and clear – ‘No’. Trusts have been told to make 15-20 per cent cuts and as the Royal College of Nursing reported last week these are cuts to frontline staff not just managers.
Abolishing local primary care trusts (PCTs) (amongst others) and putting local GPs in charge of the budget (£80 billion) buying our healthcare may be appealing to some GPs. From my experience as a former PCT Chair there were always a few enterprising GPs who wanted to take advantage of incentives to extend their businesses, eg opening new surgeries in supermarkets; but the vast majority of GPs just wanted to care for their patients. There is no evidence to suggest that this position has changed. Even the British Medical Association’s GP Committee has concerns saying if GPs are to be forced into these new consortia they will need support to work together, eg, costly locum replacements to cover when they are in meetings and not in surgery or on visits as well administrative, financial and contractual help.
However, most alarming are how these plans open the door for the private sector to both commission and provide healthcare in the NHS. I have no problem with private healthcare companies being used by the NHS if they add value or capacity, but I vehemently oppose any ideologically-driven proposals that in effect hand over our much-loved NHS to the private sector. Why? These companies are here to make money; the decisions they make, eg which patients are ‘profitable’ (people with existing, complex conditions, usually the old and poor, are not), what medicines to use, will be guided by profit margins not clinical need. Many GP surgeries are already owned by private companies like Care UK and Assura (soon to be owned by Virgin). Through GP consortia these companies will have increasing control of NHS funding including contracting with private sector foundation trust hospitals. Mr Lansley’s soothing rhetoric that these companies are ‘social enterprises’ is misleading; according to the coalition BUPA is a social enterprise company! In spite of equity having such prominence in this white paper’s title these plans will deliver the opposite.
As the recent reports on health inequalities by Michael Marmot and the Audit Commission, show we need to tackle the socioeconomic causes of health inequalities as well as improve access to healthcare for people who need it most. We must challenge the coalition to present evidence that indicates their plans will reduce health inequalities in all areas and between different population groups. We cannot allow them to get away with the same, lifestyle-focused quick-fixes of the 1980s and 1990s blaming the victims for their poor health. It is injustice that is killing people on a large scale and we must reclaim the agenda on equality and fairness. The ConDem coalition’s talk of fairness is just that – talk.
At last someone that understands liberating the NHS is distroying it.It is like saying you can run nation wide Sainsburys with just check out assitant – no disrespect to them but it can not be done without damaging the service given. As someone that has worked in the NHS for 20years – Yes morale is at all time low. The private sector must be delighted and waiting to cherry pick not only what they deliver by also the most talent staff from the NHS.
GPs have been frustrated for too long at reading of new expensive drags but not being able to prescribe them. Now they’ll be able to do what they want without all that wasteful accountability rubbish that the Labour Party imposes on them. As for the expense, most GPs are members of respect; cost is not an issue to them as long as they know who’s to blame when the money runs out.
Milton Freedman (Thatcher and Reagan’s guru) advised us in the early 1980’s that the NHS was a financial burden to our economy and that we should get rid of it. I am quite sure that the Thatcher government was intending to achieve this by gradual erosion, and some of us remember how she encouraged more of the better off to ‘go private’ by arranging percentage reductions in their insurance premiums. This is clearly what Andrew Lansley’s program is all about. The idea that GP’s can run the NHS as a set of competitive business units is ludicrous. Eventually they will have to re-evolve as private businesses with fund managers.The final move will be to fund these through private insurance which will be controlled by the drug companies as in the U.S I am sure that most Tories have a huge admiration for the U.S health system, but few would admit it.