NHS Goes Under the Knife

Will New Reforms be Make or Break for Cameron?

The new reforms to the NHS brought in by the Tories and Liberal Democrats have arrived and, some say, not a moment too soon. Though some claim that the NHS does not require change, the real issue is whether these particular changes are necessary and whether they are the right way to go about changing an organisation that has always been a symbol of what is great about British society. In essence, can Cameron show that he can be trusted with the NHS?

Unfortunately these reforms cannot be given a snappy summary or inspirational catchphrase like the Coalition’s campaign for ‘making work pay’ in welfare. Indeed, it’s taken a while for the reforms to be properly explained and understood, with Cameron only successfully defending his proposals in early February on the BBC Breakfast show. What these reforms ultimately boil down is the move to establish a ‘GP commissioning consortia’, which will handle commissioning treatment, worth over £80 billion after the government axes two tiers of administration from within the NHS. The consortia will be accountable to a new independent ‘NHS Commissioning Board’, which will allocate budgets and oversee the reformed service.

Can doctors really be expected to provide the best care for patients whilst keeping their hold of the purse strings to their treatment? The Royal College of Surgeons (RCS) has isolated this question as one with which they have a particular concern. They argue that, while they support the government’s aim for finding the best value in health spending, there needs to be greater detail in the proposals if we are to avoid a situation where doctors focus on lowering costs and cause a ‘race to the bottom’, with price squeezing out quality. Furthermore, even if they can fulfill this dual responsibility, is it fair that they should carry the weight of this? While Cameron is keen to establish that individual doctors will not be under individual pressure to make financial decisions, it is worth questioning how much of this claim is merely the classic pitch – the government trying to defend their already highly contentious proposals for the NHS? Even then, though, doctors may not be under individual pressure; the proposals do amount to a group of around just 15 doctors being responsible for a whole borough.

The Government’s Health Secretary Andrew Lansley has argued that these worries are unfounded. Not only is he adamant that while the BMA and RCS have both raised concerns with the reforms, they do have the full support of clinicians who claim that “with rising demands on healthcare and results for patients – like cancer survival – not even at the European averages, the NHS needs to modernise now.” However, stating that the NHS needs reform does not justify the repercussions of these specific changes. What has not been made clear is why this path is the best one for government to go down.

Ultimately these reforms are proving very controversial, especially with influential institutions like the BMA expressing their strong doubts about the speed at which the changes will be made. This being the case, it may seem unreasonable to expect a government with the life span of just five years at to push forward with such ambitious reforms that have such a long-term application period; these reforms may only provide their financial benefits in the next Parliament.

Out of all the changes made by the coalition this will be by far the most important. The consequences will be Cameron’s defining moment as our Prime Minister. Even if the results are catastrophic, he will be remembered for transforming our most treasured and significant institution.

Ruth Edwards

7 Comments on this post.
  • Robert
    6 March 2011 at 11:30
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    I notice on the first article you have a map with the Tories and it covers Wales, Scotland sorry but this is sod all to do with Wales or Scotland the NHS is devolved.

    This is about how England See’s the NHS

  • Your NHS in the news this week – 28 Feb to 6 March | Big Society NHS
    6 March 2011 at 12:10
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    […] journalists at the University of Nottingham joined the chorus of opposition to the reforms in an article spelling out the series of problems with Lansley’s reform plans.  Grassroots activity seemed to flourish elsewhere with health […]

  • Heretic
    6 March 2011 at 12:41
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    At the risk of being burned at the metaphorical stake… isn’t this just tinkering with a system in need of much more radical restructuring? Why is it that we spend more per capita on healthcare than any other European nation, but have dramatically worse results in terms of survival rates?

    • Keosis
      7 March 2011 at 07:39
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      The health outcome appears worse in England even though it spends more on health because the British thinks health is an entitlement not a product of individual responsibility. It is because those who are receiving treatment for respiratory problems continue to smoke, those with liver problems continue to drink and those with heart problems refuse to exercise and continue to binge on junk food. It has very little to do with how the NHS is run or who controls the budget.

  • Richard Hamilton
    6 March 2011 at 19:41
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    The real question is not “does the NHS need reform” as all industries need change. The question is – now the previous reforms’ effects are being seen, is a change of course a good idea?

    Four reasons it may not be:
    1. The reforms to date have a good track record: Extra funding plus free choice of NHS or private hosptials for planned surgery has been a success, and fixed the biggest problems the NHS had in 1997 – huge waiting lists. People would wait 6 months for a consultant opinion, then up to a year for diagnostic tests, then up to 2 years for surgery. Now the average wait is less than 8 weeks for the whole process, with over 95% of people waiting under 18 weeks.
    Public satisfaction with the NHS is at a 30 year high, and despite intuitive dislike of targets, the stories of people spending 20 hours on a trolley in A&E are long gone.

    2. There is no evidence the changes will do us any good – quite the contrary : The published evidence about the effect of giving budgets to primary care doctors comes from the states – there were some initial savings, followed by a significant proportion of primary care doctor practices going bankrupt, followed by price rises again. Perhaps this is why 3 in 4 GPs, the very doctors who are supposed to gain extra freedoms and influence, are opposed to the reforms

    3. The case that getting the best health outcomes demands major change is flawed: It is claimed that outcomes such as cancer survival rates lag behind other countries. However, as the Kings Fund chief economist and others have noted, our rate of improvement is faster than other countries in many of the health outcomes cited as cause for reform, and if we keep to current rates of improvement we will be better within 2-3 years, without having to spend the much higher % of GDP that these other countries do.
    The commonwealth fund’s comparison of major health systems showed the NHS fares better than the more market based systems in a range of measures – outcomes, efficiency, access to care, and equity. Why make our system more like those that cost more and achieve less?

    4. The inept method of achieving the change causes needless disruption and damaging distraction from the main task the NHS faces: The Chief executive of the NHS has pointed out that the level of efficiency and cost reduction, to fund the extra treatments we all need when the population gets older, is £20 billion in 4 years (20% of the NHS’ budget). This is a level of improvement that has not been achieved in any healthcare industry anywhere in the world in history. You might think such a change plan would need to be brilliantly planned and executed by motivated leaders, and even then most change efforts of this scale fail. So how sensible is it to put the jobs at risk of almost 100,000 people who would lead these changes? In order to scrap organisations (PCTs) and then set up replacement organisations (GP Consortia) who will likely re-employ the staff previously made redundant at the public’s expense, at a cost of £3 billion. Talented staff are leaving in droves, and with major gaps in staffing, all organisations can do is keep day to day operations running and safe, rather than deliver major change.

    All in all, the jury is not out, there is no case to answer. Expect a financial car-crash, and a slow down or worsening of health outcomes, and a rather enormous financial bill to get us back to almost the same place.

    The key question is whether, given the considerable success of reforms to date, an acceleration or evolution might have achieved much more, at much less disruption and cost. It seems we will never know.

  • Paul
    6 March 2011 at 21:21
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    NHS goes under the knife… Again. In 1991 the Conservatives introduced GP fundholding and in 1997 Labour scrapped it. I, like many others that work for the NHS, will not be holding our breath. Axing two tiers of administration, whatever that might mean, will not happen. Wherever the huge budgets sit it will need an equally huge administrative workforce to manage those budgets.

  • Dr Kadiyali M Srivatsa
    7 March 2011 at 06:44
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    Does NHS need reforms?

    I feel its is essential because the cost of providing healthcare has escalated to catastrophic proportion. No individual nor the government can afford. This is mainly because the pharmaceutical companies shifted their role from developing cures to developing drugs that suppress symptoms and used long term. Prescription drug reward an investor the best passive income and is said to cost healthcare providers (like NHS) with hefty bill.

    Where did the NHS go wrong?

    In 1980s, the GPs were funded by the number of patients registered so single handed GPs joined to-gather and formed group practice. They also invested and built purpose built surgeries and increased patient intake. The cost of providing care increased as the emphasis was on investigations and using equipments. Some surgeries based in affluent area had younger health population and the GPs earning was increased but their work load reduced as they were sharing their on-call rota.

    I worked in a surgery managed by nurses in an ethnics minority populated area were sickness due to poor living condition and OAP population was high were. We were not lucky to be included in a group practice and I felt sad as a doctor but helpless. I think this is un-fair and felt its is un-ethical to offer poor sub-standard care to people who need help. As I have not been successful in bringing in changes, I have decided not continue to work as a doctor in NHS.

    What Problem Will We Encounter In The Future?

    The threat of super bugs is real. Similar to H1N1 we are likely to encounter more virulent bacteria and viruses in the future. Doctors have no medication to cure and the pharmaceuticals have just started investing in Antibiotic/Antiviral drug R&D. When compared to pre-penicillin era, we are in a worst position, so a good healthcare system is essential to take care of sick and dying.

    We must reduce cost of care by reducing blanket payment to GPs for registering your name and patients must access service only when essential. By using my tool the number of patients visiting a GP can be reduced by 80% and by removing the ghost patients we will have more funds at disposal to take care of the sick and needy.

    I have been trying to get this message across as it is vital for the future of our children.

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