“What is your opinion of the NHS reforms?” I asked one consultant from Manchester. The response was less than enthusiastic.
“It’ll be a shot
to the head of the NHS.” The proposed Health and Social Care Bill 2011
has been dubbed the most radical plan in the history of the health
service – and it certainly has proved controversial. It’s been labelled
as both the end and the saviour of nationalised British health, but with
all the mud slinging between politicians, unions and healthcare groups
it’s tricky to know what all the fuss is about? Where do we, as present
and future patients and potential employees of the nation’s largest
employer, stand?
Perhaps it’s wise
just to take a step back and look at how many people it’s going to
affect. The University of Manchester is the largest face-to-face
teaching university in the country, having over 3,200 current students
on nursing, midwifery and medicine courses. Without taking into account
psychologists, life scientists and every other student with ambitions of
working in the healthcare system, it makes up fewer than 10 percent of
our student population. The NHS employs over 1.4 million people- that’s
more than 5 percent of UK’s working population. But most importantly,
these are changes that affect almost all of us. No matter how strong we
think or feel we are, one day we will probably need NHS treatment. As
such an important feature in our lives, any change to the NHS needs to
be understood and supported by the public. I’m going to explain the
current structure, outline the why and how of the reforms and discuss
the numerous views surrounding them.
Why are the reforms being proposed?
There’s no
getting away from it; the world is in financial meltdown. With
governments all over the world scrounging for pennies cuts are being
made across the board and the NHS (although technically ‘ring fenced’)
is undergoing readjustments to make it ‘more efficient and cost
effective’. Essentially, the NHS is attempting to save £20 bn by
2014-2015, which kicks David Cameron’s electoral pledge “Cut the deficit
not the NHS” into the dustbin. Considering this reform will be rolled
out in 2013 at the earliest, you’re looking at a whopping £10 bn saving
per year across the NHS. However, Cameron has promised that the actual
money put in to the NHS will still rise year on year. Critics argue that
this is a facade; that in reality he’ll be reducing the annual increase
in the NHS budget. The extra money that is being put in each year will
be swallowed up by rising inflation, meaning that the actual monetary
value the NHS gets will decrease.
A quick look back
at history has seen spending on the NHS triple since 1999 from £40 bn
to over £120 bn. However, looking at figures relative to British GDP per
capita we still put in less money per person than almost every other
nation in Western Europe and North America. Despite this, all major
political parties have described a need to curb the rising costs in the
NHS whilst making it more efficient. The Health and Social Care Bill
2011 is the coalition government’s proposal to do this.
How is the NHS currently structured?
At the moment the Department of Health controls the NHS. The Secretary of State for Health, Andrew Lansley, is the head and reports to the Prime Minister. The Department of Health controls England’s 10 Strategic Health Authorities (SHAs), which oversee 152 Primary Care Trusts (PCTs).The PCTs control local NHS activities. The devolved administrations of Scotland, Wales and Northern Ireland run their local NHS services separately.
Primary Care
Trusts control approximately 80 percent of the budget and are
responsible for distributing the money to GPs and hospitals as well
changing their services to suit the needs of their populations. So, if
Manchester had an increase in patients with diabetes, then they would be
expected to provide more services to support those with diabetes. The
PCT would plan effectively how to use their budget to accommodate their
new needs.
The role of the
Strategic Health Authorities is to provide leadership in the area they
serve by organising workforce development and ensuring PCTs are looking
after the needs of their populations. Essentially, they are the
overseeing body that will dictate the numbers of staff needed across the
region in different areas. For example, if the North West were low on
anaesthetists they would call on deaneries responsible for training them
to increase the numbers they train so that the whole SHA can benefit.
They also are responsible for finding specialist services for conditions
that some PCTs can’t treat.
Currently there
is a large emphasis on cooperation between PCTs to provide the best
possible service for patients by taking a national, regional and local
perspective on health.
What are the proposed reforms?
The NHS will
undergo a radical pro-market shakeup with hospitals, private healthcare
providers and family doctors competing for patients who will be able to
choose their own treatment and care options.
They will do this
by abolishing all PCTs and SHAs, therefore culling more than 24,000
management jobs. Budgets will be directly paid from Department of Health
to newly formed GP consortiums, which will be groups of GPs responsible
for a certain area. A National Health Commissioning Board will be set
up to supervise the GP consortiums to make sure they are doing what they
are supposed to.
The increase in
competition will provide a change from a unilateral service to one with
more ‘choice’. Say for instance someone went to his GP and was told he
had a funny looking lump on his shoulder that the GP wanted to have a
closer look at. The GP would then request an X-ray. At the moment the
patient would go to a local hospital to have it done. If the reforms
take affect the GP and patient would now have a choice between several
providers. For this example we’ll say a Private Hospital is charging £60
and a local NHS hospital is charging £80. Most likely the GP will try
and convince the patient to go to the cheaper one because he is mindful
of his budget. If the patient doesn’t, he can then go and complain to
the ‘Monitor’, who is there to ensure ‘patient choice’. The powers of
the ‘Monitor’ haven’t been well defined so it is not known if they will
actually be able to intervene effectively. This also raises questions
over the effect it will have on doctor – patient relationships as the
patient will know the doctor’s decision may be influenced by the budget
the doctor himself set out. He could directly ask him,
“why haven’t you set enough aside for my X-ray?”
This increase in
competition you might think could lead to a decrease in NHS patients
going to NHS hospitals, causing the NHS to shrink. Well the government
has a plan for that. There are already a number of hospitals that have
‘Foundation Trust’ status and the Government are pressing for more and
more hospitals to convert into them. These ‘Foundation Trusts’ have
several powers that enable them to chase private patients (those with
individual health insurance) and therefore bolster their own revenue so
that they are not solely dependent on the money given to them by the
government for NHS patients, thus enabling NHS hospitals to challenge
private healthcare providers. However, this has raised concerns that
these ‘Foundation Trusts’ will lead a charge by the NHS for private
patients causing a decrease in access to healthcare for NHS ones.
Who is against the reforms?
It all sounds
rather good, with more choice for patients and reduced costs over the
whole of the NHS. But the plans have drawn sharp criticism from many
interest groups. UNISON, the biggest trade union in the UK with over 1.3
million members, said
“NHS patients will be the biggest losers if the Government pushes through its Health and Social Care Bill.”
More opposition
comes from the Royal College of Nursing. With over 400,000 members, they
took the unprecedented decision to vote 96 percent in favour of a no
confidence vote in Andrew Lansley. You might think that the Royal
College of General Practitioners (RCGP), whose members will be handed
increased power, would be happy but they have also expressed concerns
with the changes,
“They [our
members] worry about the financial pressures, and the competition
culture of ‘Any Willing Provider’. They fear that these reforms could
cause irreparable and irreversible damage to the NHS.”
The British Medical Association (BMA) who is to all intents and purposes a trade union for doctors working in the UK said;
“The BMA continues to call for the Bill to be withdrawn or, failing that, to be subject to further significant amendments.”
Finally, Ed Milliband, leader of the Labour party, went a step further and attacked the Prime Minister,
“It is an insult
to the people who work in the health service, it is an insult to the
people who use it and the Prime Minister should be ashamed of the way he
is running the NHS, the proudest institution of Britain.”
It all sounds
pretty fiery with anyone and everyone getting hot under the collar about
it. So why are so many vehemently against the reform? The issues stem
from several key areas.
The first being
that GPs are now expected to become managers of their accounts whereas
before much of the administration of the NHS was done by trained experts
on PCT boards. Dr. Azeer, a GP of the Bury PCT, stated,
“I’ve had 15
years of clinical training, how am I expected to suddenly be an
accountant as well?” A concern echoed by Conservative MP and GP, Sarah
Wollaston, “It is one thing to rapidly dismantle the entire middle layer
of NHS management but it is completely unrealistic to assume several
hundred inexperienced commissioning (GP) consortia can take their
place.”
Worries have also
been raised that GPs will now have even less time with patients as they
are forced to spend valuable time organising finances for their
regions. Ironically, it is feared that GPs will resort to paying
increased fees for managers that originally worked for PCTs absolving
GPs of their new responsibilities and completely negating the desired
effect. For students there may well be a reduction in training
opportunities. Medical training is carried out entirely at NHS hospitals
and under new proposals a lot of patients will now be going to Private
Hospitals instead. Even Lord Nebbit, a Conservative pier in the House of
Lords, has expressed concerns;
“It’s fine for
the private sector, which doesn’t have responsibility for teaching and
bringing on young surgeons, to take the straightforward and easy stuff.
But that means unsecured loans the public sector is then left without the base of work
to subsidise the more difficult surgery and the teaching of surgeons.”
With the
abolition of the SHAs and PCTs there could be a lack of national
oversight on health policy which will leave a fragmented NHS struggling
to cope with the needs of patients on a national level as well as a
local one. An example of this, is there being no government body to
acknowledge the need for changing numbers of different types of doctors.
Regardless of
these fears, a massive question remains that these changes may not
actually see a decrease in costs in the NHS as the implementation of the
reforms will cost over £2 billion in themselves and then the further
re-organisation of the NHS bad credit loans could cause costs in the NHS to spiral out of
control.
What next?
The reforms have
passed through the House of Commons and are now in the House of Lords at
a committee stage. This stage can take several months where infinite
details are haggled over until a compromise is met before a final
amendments stage. Groups such as the Trade Union Congress (TUC) and 38
Degrees have online petitions calling for the Health and Social Care
Bill 2011 to be halted. Whether these reforms go through or not could be monumental for the NHS and as one of the future generations it is our
responsibility to let our voices be heard. If I am to leave you with one
final thought, it is to consider our trans-Atlantic cousins who, also
struggling in a financial crisis, have given the go-ahead for a national
health service of their own. Is this really the time to start
unraveling ours?
Halifax has been doing some digging into our quality of life in Great Britain.
Fish4Dogs is very proud to support Dogs for the Disabled’s work and urge dog owners to sign up and take the Wag n Train challenge. The Worcestershire based dog food manufacturer is supporting the 