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What struck me most is that even after the NHS reforms had been in the public pipeline for some time, I still wasn’t entirely clear exactly what was in store, and nor were lots of others. I’ve made it my job to find out.
The new measures will see Primary Care Trusts, the local bodies currently tasked with allocating NHS resources to where they’re needed, abolished, and replaced by groups of health professionals who will ‘commission’ the resources instead. The cost will be to the tune of £1bn resulting largely from the redundancy pay-offs that’ll be made to 21,000 PCT workers.
The argument is that health professionals, not bureaucrats, are best placed to decide what local GP practices and patients need. Sounds pretty sensible.
But do we want GPs to become accountants too? Aren’t finance and healthcare at loggerheads with each other? Treatment will remain free at the point of use for patients – a key value running through the NHS’s veins – but will it remain free at the point of use for GPs? Doctors could find themselves in a bit of a pickle here.
At the heart of the Coalition’s 457-page NHS reform law, however, is the idea of patient choice; empowering patients and to make informed decisions about their own healthcare provision. The policy change here comes in the move from a ‘preferred provider’ model of healthcare to an ‘any willing provider’ one.
What does that mean in human terms? It means that instead of most services being delivered exclusively by the NHS, any organisation, be it in the public, private or voluntary sector, that offers good quality care will have an equal opportunity to provide it patients on the NHS’s behalf.
What’s caused the furore over these reforms, though, is the impact of this patient empowerment on the various providers of healthcare. If patients get to choose from a list of different providers, those providers are going to have to compete with each other for the patients’ custom.
On the one hand, this competition could be a pretty nifty mechanism for driving up quality in the health service – patients will choose the best provider, so providers will compete to deliver the highest quality of care; there will be a race to the top.
On the other hand, we could find ourselves with an NHS dominated by private providers. We could be in danger of having an NHS accountable, not to patients or the people on the ground, but to what could become a market of healthcare.
“We should be cautious over these changes, and we’ve got every right to be. But we should also be cautious not to dismiss what is an opportunity to improve our healthcare system.” Not only are we in a dire economic situation where government has been spending more than it’s been earning in taxes, but we’re also faced with an aging population which is putting a strain on NHS budgets and services.
We should be open to the idea that the provision of services by the state is just the tip of the iceberg of an effective welfare system. Beneath the surface, the state can also regulate and finance healthcare, and leave the provision to those who can provide good quality services for good money.
The bottom line is: our society is changing, and the NHS must change with it.