My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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“The NHS reforms are a basket case. They haven’t been thought through”

Filed Under (Health and Social Care Bill, Health Policy, Liberal Democrat Party, Reform of the NHS) by Paul on 09-05-2011

Every now and again you catch people who are not very interested in the detail of an issue that really matters to you, like NHS reform policy, encapsulating how the rest of the world sees that issue.

Last Friday and Saturday, following the pretty historic elections in Scotland and on voting reform (and less game changing elections in England and Wales and Northern Ireland) there was a lot of general political comment on the airwaves. There was an occasional mention of the NHS.

But on Saturday morning BBC news had a discussion between three political commentators who broadly presented the views of the three main political parties. In discussion, there was a suggestion that Lib Dem MPs would be looking harder at the NHS reforms. The Daily Mail columnist – representing Conservative opinion – jumped in to say that it wasn’t only the Liberal Democrat MPs that would be asking questions – all Conservative MPs would too.

He said “The NHS reforms are a basket case, they haven’t been thought through”. Every one nodded.

It struck me suddenly that this has now become a simple truth for people- a received wisdom of the world.

The fact that Andrew Lansley had been in his attic thinking these reforms through for six years apparently has no impact on this current explanation. Received wisdom is that no one could have thought these reforms through because they so obviously don’t work.

The most significant issue for the reforms is that there is now a feeling that they are “bonkers” and that if the Tory party doesn’t want a complete disaster on its hands they must be changed.

Then, on Sunday, Nick Clegg speaking on the Andrew Marr programme said two very important and interesting things.

Firstly he said that it would be better to have no Bill than a bad Bill and that he would not ask Lib Dem MPs to vote for a bad Bill. This provides the Government with a radical way out of the mess if they want to take it. Just stop. Review the wreckage of the NHS and start slowly to think about what to do.

Secondly he said that he thought it should not be the case that GPs were being told that they had to carry out commissioning. This was always one of the madder parts of the reforms. Making GPs do anything is very hard, but something that is of such strategic importance and needs very willing and energetic volunteers, is really daft. Conscripting GPs was never going to work.

So I think we have our first major change to Lansley’s proposals. GP Commissioning will no longer be compulsory. Parts of England will have this and parts will not. We will have a mixed system.

This one change, changes nearly everything. If PCTs had not already been de facto abolished, they would be reprieved.

Obviously there will be more to come.

However on the ground there are already significant changes happening for patients.

Last Thursday I received my first email advert from a private medical insurance company that was selling to me based clearly upon the impact of the Government NHS reforms. A firm providing users with an overall analysis of all private medical insurance, Your health, your choice, beat that quote. Their offer recognised the return of waiting lists to the NHS, something that had become a thing of the past,

“With this type of insurance you are able to avoid NHS waiting lists and secure treatment as quickly as possible.”

Those selling private medical insurance recognise the anxiety that people on NHS waiting lists feel. They recognise that waiting lists have increased over the last year and that therefore they have an opportunity to sell to people on those lists.

The Government have withdrawn the necessity for the NHS to reduce waiting times and by doing so have renewed a market for private medical insurance that had been diminished by the success of the 18 week target.

Up until this time last year I thought the NHS had won this issue. But in one short year the basket case that is NHS reform has increased waiting lists and reopened this market.

Comments:

4 Responses to ““The NHS reforms are a basket case. They haven’t been thought through””


  1. [...] months on and the NHS reform is in disarray. Lansley is under threat, possibly from a Lib Dem whose views on the NHS are more radical than his [...]


  2. It is with increasing irritation that I see the dismantling of our social services. The politicans of today are meant to be public servants, to serve the public. Yet, we see with increasing arrogance, a basic negligence of their duty to do so. We are therefore forced once more to defend our NHS from a few people who think it is there’s to do as they please. The privatisation and free market mentality has proven itself time and again to fail the consumer, the worker and the purse of the government.


  3. One of the big issues under discussion on the clinical leadership section of the listening exercise website is the role of public health expertise in commissioning – ie health care public health – ie needs assessment, evaluation, literature review, prioritisation.
    The Faculty of Public Health, BMA and GPC and the Health Select Committee have said this advice is still necessary and public health should be on GPCC boards. What is your view about public health expertise being effectively removed from the NHS?


  4. Dear Rachel

    I don’t think any reading of the Government proposals could see them as removing public health from the NHS.

    There would at least be some public health professionals who would be happier for the core of public health to be based with local government and quite a few public health professionals felt that PCTs did not empower them. It looks almost certain to be that the changes to the accountability regime will recreate PCTs with a wide range of different interests including having public health having to be on GP Commissioning Boards. As I say quite a few public health professionals did not feel that being on PCT boards gave them any power at all, so I don’t expect these new arrangements will.

    Where public health is very fully empowered is where it makes a substantive case to commissioners for how practical public health interventions improve the health care that is being commissioned. Being on the board may make this a bit easier, but it does not make it inevitable

    Paul

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