NHS reforms: a guide to the controversial bill

Jan 19, 2011
Tim Edwards

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.

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I think the NHS needs a shake up and getting rid of top heavy management! but Doctors are hard pressed and overworked do not need this extra task put on them, their job is treating patients not running the NHS. This new reform is putting the NHS out to be run privately by groups of doctors. This could become  a very unfair NHS