SPECIAL REPORT: REFORMING THE NHS IN ENGLAND
Above all else though, the objection that is most common to the ranks of the doubters is that the reforms open the way to the privatisation of the NHS by stealth.
wishes, will give better value for money than the one it replaces? This is a subject on which everyone has an opinion but to which no-one has a complete answer. Proponents of the proposals presage their outcome as a world class health system. Opponents say they’ve heard it all before and suggest that it is more likely to result in re-disorganisation than reorganisation: a set of good intentions that will pave, as good intentions are said to do, yet another road that will lead somewhere far removed from heaven. The many doubters perched on the middle ground of the argument warn of ‘more haste, less speed,’ recommend evolution not revolution, and speak of pilot studies. And since the roll of doubters is long and impressive, it is worth looking at it and its concerns a little more closely. The names on the list include the British Medical Association, the Royal College of Nursing, the Royal College of Surgeons, the Chartered Society of Physiotherapy, the Society of Radiographers, the Liberal Democrat Party, the King’s Fund, the health unions, health charities such as Diabetes UK and the British Heart Foundation, and individuals like Baroness Williams of Crosby, Lord Winstone, and – more importantly – a fair number of GPs and their patients, especially the older ones.
Bones of Contention The bones of contention that concern this array of critics range from GPs who don’t want to be commissioners and would like to be able to decide on their patients’ needs without having to be concerned about the cost; and hospitals that don’t want to lose services to the community and have their budgets cut; to anti-centralists who fear that the powers of the proposed NHS Commissioning Board and the NHS economic regulator Monitor will be much too wide-ranging in a reform which is supposed to devolve power to local clinicians. Above all else though, the objection that is most common to the ranks of the doubters is that the reforms open the way to the privatisation of the NHS by stealth. A fear far from allayed by the recent remarks of the new chairman of Monitor, David Bennett, who favours more competition in the negotiations regarding medical services with the NHS contracting system operating on much the same lines as procurement in the defence industry.(4)
The “Future Forum” So what is likely to happen in practice? I believe that there will be some amendments to the Bill, with the scheme as originally presented being altered as a result. Indeed, the Bill’s progress 4 | WWW.PRIMARYCAREREPORTS.CO.UK
through Parliament is already paused to allow for fur ther discussions with patients’ representatives and NHS staff (especially nurses) via a Future Forum chaired by former Chairman of the Royal College of General Practitioners, Dr Steve Field. The Government sees the new Forum as a channel for the thoughts and opinions of patients and staff and Dr Field has already said that, since listening to the NHS people on the ground is vital, he sees the new group as a real chance for these people to have their say in helping to shape the future of the service. The Future Forum will focus on: - the role of choice and competition for improving quality - how to ensure public accountability and patient involvement in the new system - how new arrangements for education and training can support the modernisation process - how advice from across a range of health care professions can improve patient care. Speaking at the Forum’s launch, the Prime Minister assured the public that any good suggestions to change the current legislation which arise from the discussions will be accepted, but reiterated his view that modernisation of the NHS is essential if we want a truly world class service. The Health Secretary insisted that good progress towards modernisation had already been made such as the 6,500 GP practices and 90% of Local Authorities signing up to play their part in improving services for patients.
Likely Amendments to Proposals As for the results likely to be recommended by the Forum when it reports in the early summer, Dr Field has already commented on some obvious needs that it must address – such as stopping the ‘cherry-picking’ of NHS services by private companies, the protection of workforce training, and the addition of hospital doctors, nurses and other health professionals to the new GP Consortia. Obviously, despite such changes, the Government will proceed with its basic plan, because, in a time of financial freeze and widespread cuts, they need the savings that reduced hospital care and the abolition of the PCTs and SHAs will bring to have more money to spend on maintaining and improving frontline services. And there are reasons, I believe, for hope that they may be right. Giving GPs the purse-strings to buy secondary care certainly adds to their responsibilities, but it also has a ring of common-sense about it, as