28 minutes to spare? Want to understand the NHS reforms better? Here’s a place to start…

by Stephen Tall on April 5, 2012

I’ve written very little about the NHS reforms. In many ways thankfully, my personal involvement with health-care in this country has been pretty limited, a mix of excellent and poor with a little inbetween.

I hoped to learn more during the recent Health and Social Care Bill debates, but there was remarkably little impartial analysis of the issues. Positions had become too partisanly entrenched between those who claimed the Bill was wholesale privatisation that would kill off the NHS, and those who claimed the Bill would be our only hope of saving the NHS for future generations.

From all that I have read and understood of the Bill both those claims strike me as ludicrously hyper-inflated.

But I listened this week to an enlightening and seemingly balanced assessment of the NHS reforms on BBC Radio 4’s The Report — you can listen to it via the BBC website here — and this report by presenter Simon Cox offers a flavour of what the Health and Social Care Bill will mean for patients living in England.

There’s positives…

If you want to know what the NHS reforms will mean for patients, Specsavers in Cambridge is a pretty good place to start.

Upstairs in a small office, audiologist Georgie Noble is giving patient Margaret Manson some tips on using her hearing aid when answering the phone. Mrs Manson had it fitted at Specsavers for free on the NHS.

Specsavers has a contract with the health service to run clinics twice a week for NHS patients. GPs ring a booking line and, normally, a few days later the patient is seen at the clinic.

“The feedback has been really good so far. I believe from the referral to the first appointment it is a lot quicker,” she tells Radio 4’s The Report.

Mrs Manson was keen to get her hearing aid as soon as possible:

“I asked ‘how long will I have to wait for it?’ and they said ‘you don’t, you take it away with you’ which I thought was a fantastic service and I walked out of here like a new person,” she says, happy she can now hear the world more clearly.

The alternative to this was a trip to the local Addenbrookes hospital – a trip Mrs Manson did not relish: “I’m not a great lover of hospitals by a long way and I was lucky enough to choose to come here.”

And there’s negatives…

GPs argued for years for a greater say in how the NHS budget should be spent, taking this power away from PCT managers.

In some of the areas where they are piloting GP commissioning, some doctors are starting to have second thoughts.

Dr Peter Bailey was vice-chairman of the Cambridgeshire Clinical Commissioning Group until he recently retired.

Initially an enthusiastic supporter of the reforms, he remembers the first time he sat down with his colleagues who were preparing to take over control of an £850m budget:

“Most of us felt a little under-prepared,” he admits.

“I thought ‘who here actually knows how to negotiate an NHS contract?’ Not one of us.” Dr Bailey says he was left feeling “like an enthusiastic amateur”.

In the past doctors had been able to blame managers for budget decisions, but under the new system the buck stops with them as the previous layer of budget managers working for PCTs is being abolished.

If you have 28 minutes to spare, it’s well worth a listen. By the end of it, I’d reached three conclusions:

1)

Andrew Lansley had been shadow secretary of health for six years prior to the Coalition, and the reforms appear to have taken little account of the £20bn efficiency savings needed by 2015. I’m in favour of GP commissioning — and against professionals seeking to shrug the blame for failures onto professional managers — but the combination appears risky.

2)

Panic about the role of private providers within health-care is massively overblown. I want a health service that is free at the point of use regardless of means, and offers high quality, appropriate provision. I’m neutral on how that is best delivered, but do not believe it will automatically happen perfectly if left to a state monopoly, or that it will be abandoned if the private sector is involved.

3)

Coalition politics has not come out well of the NHS Bill. This is a depressing conclusion for a pluralist to reach, as I’ve always believed that politicians of different stripes getting round a table will make for better politics. Yet in spite of the best efforts and good faith of Lib Dem peers I’m by no means convinced we’ve ended up with a better Bill. Thousands of amendments to dilute private sector involvement have been achieved only at the expense of passing a prolix Bill which is unmanageably gargantuan and complex. (I at least take comfort from the fact that perhaps the best piece of legislation to date in this Parliament — the higher education bill legislating for £9k tuition fees — emerged all the better for the creative tension generated by the coalition of Vince Cable and David Willetts.)