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NHS reforms: a guide to the controversial bill
Briefing: Why the NHS reforms could be David Cameron’s poll tax
Health secretary Andrew Lansley has laid out his plans to reform the National Health Service in the Health and Social Care Bill, telling MPs: "Modernising the NHS is a necessity, not an option, in order to meet rising need in the future we need to make changes."
The coalition government's proposed reforms have been described as the biggest shake-up of the service since its foundation in 1946.
The extent of the changes has been seized upon by political opponents, who denounce them as privatisation by the back door. They say neither the Conservative nor Liberal Democrat manifestos at the last election gave a hint of the plans.
Prime Minister David Cameron faces a hard time selling his proposals to a sceptical public that is actually quite satisfied with the NHS and the reforms are also unpopular with health professionals.
Ominously, no less a free market cheerleader than the Financial Times has suggested NHS reform could become Cameron's poll tax.
What are the key reforms? Currently, 151 Primary Care Trusts (PCTs) in England are in charge of the health budgets in their local area. PCTs plan services such as GPs and buy health services from hospitals and other providers. The reforms will remove this money from PCTs, which will be abolished, and hand it to groups of GPs.
These new GP consortia - which will be compulsory by April 2013 - will be in charge of purchasing care to the value of £70bn-£80bn. If your GP decides you need treatment, he can choose to purchase it from a range of public and private-owned providers offering different prices.
A new NHS Commissioning Board independent of government will dole out the £100bn NHS budget to GP consortia and hold them to account. It will also commission some services.
The NHS will cease to be an organisation with a management structure. Instead it will be a market of competing health service providers. Overseeing it all will be a new health regulator run on the lines of energy regulator Ofgem, with wags suggesting it might be called 'Ofsick'.
The reforms only affect England. Health in Scotland, Wales and Northern Ireland is controlled by their devolved assemblies.
Why is the government reforming the NHS? Health secretary Andrew Lansley believes that GPs are best qualified to spend health budgets: "We need a healthcare system where the management of the care of patients is combined with an understanding of how resources are used."
Will the changes save money? Although the health budget was ring-fenced in the recent spending review, it is also hoped that if GPs are taking over management roles, NHS managers can be axed and savings made.
The NHS has to make around £20bn in savings in an efficiency drive that dates to before last year's general election.
What are the objections?
•The government has no mandate to change the NHS
No mention of such radical reforms was made in the manifesto of either the Conservatives or Liberal Democrats at the last general election. The coalition agreement between the two parties reads: "We will stop the top-down reorganisations of the NHS that have got in the way of patient care."
There also appears to be little appetite for change among the public, whose satisfaction with the NHS is around 70 per cent, according to polls.
•Healthcare does not lend itself to a free-market model
Currently hospitals have to charge a fixed tariff for a specific procedure, but under the reforms, they will be allowed to charge lower, more competitive prices. The British Medical Association has "concerns over the use of... deregulated tariffs in the NHS, because this system brings with it price competition, which can risk basing decisions on price rather than on clinical need".
Hospitals may drop services that are unprofitable and there would also be anomalies such as conflicts of interest in GPs both commissioning care and providing it, and the possibility that GPs who maintain relationships with trusted local hospitals could be open to prosecution under EU competition law.
•Health professionals are against the reforms
More than 100 doctors have written to the BMA expressing their disappointment that it is not doing more to fight the government's reforms. They quote a survey by the King's Fund, a charity that seeks to improve health provision, which claims fewer than one in four doctors believe that the reforms will improve the quality of patient care provided by their practice.
All this is bad news for reforms that will rely heavily on the good will and eagerness of GPs.
•The reforms are really privatisation by the back door
GPs do not work for the NHS: they are independent contractors - essentially owners of their own businesses. As such, it is assumed they will prefer to pay private companies for health services rather than publicly-owned institutions.
•'Patient choice' is bad for equality
Doctors point out at that not all patients are equal. Those who are vulnerable have to rely on their doctor to make the right choice for them. This means pushy middle-class patients are likely to get the best care, while those who are less informed could find themselves assigned to inferior care. ·
Comments
All that money invested and little improvement and its Labours fault? It was the meeting about the meeting about the meeting tha was the problem. I expect to see the fiasco of millions syphoned off by corrupt Nigerian GP's ... Daily Mail headline 2012.
The NHS is in crisis because of the excessive management burden created over the period of the last Labour and the previous Conservative governments. In addition it is in debt due to poorly controlled PFI schemes. Putting the GPs in charge of the finance is part of the answer but a balance is needed with Hospital clinical staff (Consultants and senior nurses) having an equal measure of financial control in the hospitals.
The reforms follow many of the suggestions put forward in my book The History of Medicine, Money and Politics: Riding the Rollercoaster of State Medicine by Paul R Goddard, published by Clinical Press Ltd in 2008.
This gives the background as to why changes are necessary.
Unfortunately in these times of austerity for everyone (except the bankers who caused the austerity) handing control to the doctors may be considered as a poisoned chalice. This would explain a lot of the opposition from the medics.
Professor Paul Goddard
I was completely supportive of the Labour government's move to slash NHS waiting lists by buying operations in bulk from the private sector and it worked very well. However the private sector in health is a good servant but a bad master. This reorganisation will result in the holy grail of the private sector boffins - the government will pay them our taxes (in ever increasing amounts, especially for 'wonder drugs') which they will use to reward themselves handsomely and hand over to investors as dividends. I've worked in both the public and private sector - not just in health either - and trust me, everything the NHS knows about management-speak and high salaries it learnt from the private sector. The fig-leaf of 'commercial sensitivity' should be removed for companies that receive a significant amount of business from the taxpayer.
Having worked on various IT contracts within the NHS I have seen its current shambolic state first hand. Managers, managing managers on six figure salaries who spend all day inventing more work to ensure they are keeping up with an overload of Labour-induced beaurocracy. It was actually sickening to see so much money being wasted on individuals who only seem to have a qualification in management-speak. To me, this was the biggest problem in the NHS and this approach seems like it may make a difference. And does it really matter if the NHS outsources to private companies? I think not as long as patients are getting free, high quality health care!
As a recently retired GP who lived through many re-organisations, both Tory and Labour driven, I TOTALLY support the thrust of the current reforms. Bureaucracy stifled innovative health solutions in the NHS throughout the whole period of Labour govenment. That is why, despite the laudable intentions and record increases in funding, health outcomes did NOT noticeably improve.
Give the purse strings to those closer to the patient. General Practitioners, given the right support AND incentives ARE capable of transforming the NHS into a much more efficient, patient friendly system with better outcomes.
There really isn't a lot of choice here - as can be seen by the fact Cameron is doing this at all. The original plan was to reform education in the first term - not the NHS. But health inflation and the damaging drop in health service productivity means doing nothing will kill lots of people - its that straight forward. What would be immoral would be to put political advantage ( doing nothing and avoiding blame ) ahead of the nations greater good ( improving efficiency and effectiveness - the 180degr opposite of what Labour did in office ). Markets do improve efficiency and the NHS has a lot to improve. There are plenty of vested interests who can't be bothered -but it would be a major moral failing not to take them on - like Brown refused to do to.
Certainly Mrs Thatcher had the charisma to do as she liked without listening to anybody. Mr. Cameron seems more intelligent and less charismatic. Healthcare is a huge problem which needs reforming. UK health is bad and the budgets are vast and growing. To avoid the issue would hardly be a good thing.
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