The ‘Future Forum’ chaired by Steve Field reported on the ‘listening exercise’ on NHS reform yesterday. As expected, many changes were recommended to the Destroy the NHS bill. Health Secretary Andrew Lansley is expected to respond to the NHS Future Forum in a statement to Parliament at 3.30 this afternoon.
Unions Unison and Unite continue to oppose the bill and call for it to be abandoned in its entirety.
- Conservative election poster 2010
A few recent news articles concerning the UK’s Conservative and Liberal-Democrat coalition government – the ConDem’s – brutal attack on the National Health Service.
The NHS Future Forum, set up to make recommendations on changes the health service reforms, said today there had been serious concerns voiced by staff, patients and the public.
For two months, the forum has spoken to thousands of interested parties and tens of thousands have emailed or posted their views in a “listening exercise” set up by the Government in the face of widespread criticism of its plans for NHS reform.
Their key recommendations include:
• Slowing the pace of change so reforms come in only when and where the NHS is ready.
• Keeping the Health Secretary ultimately accountable for the NHS. The plan had been to devolve power and responsibility to an independent NHS Board.
• Nurses, specialists and other clinicians should be involved in deciding which health care to buy, not just GPs as was originally proposed.
• Competition should be used to improve quality of care not to just drive down prices.
• The role of the regulator Monitor should not be to “promote” competition but to “support choice, collaboration and integration” – that is making sure all parts of the NHS work together to improve care for the patient.
• All parts of the NHS should be subject to more accountability and public openness.
Are Steve Field’s recommendations for the government enough to assuage the doubters that have blocked Andrew Lansley’s flagship bill? If the government were to accept everything then probably yes.
The point of the good doctor’s eight-week listening exercise was about “pimping a policy” – that is taking a clapped out vehicle and slapping on enough paint and chrome to make it not just acceptable to the general public but desirable.
This may not be a good thing. In repackaging the reforms Field may have conceded too much ground to opponents – and blunted the bill so much that it is a pointless mess.
Just look at the attempts to sell GP commissioning. Field says GPs should be joined by hospital doctors and nurses to commission care, and they shouldn’t be forced to band together by 2013 into consortiums.
But this means a mucky bureaucracy springing up around at least five different bodies able to buy care for patients. Lansley had hoped to only have GP commissioners in two years’ time, because otherwise you’d have a two-tier health service emerging just when budgets were being slashed. So to buy off doctors and nurses today, the government lays the ground for tomorrow’s political crisis.
There is a coalition lovefest going on over the new reformed NHS reforms, which have suddenly gone from being the worst think since the plague to the greatest thing since sliced bread, all with a few tweaks.
The problem is, it is the entire principle on which the reforms are based, not the mechanisms operating on that principle, which is fundamentally wrong. The underlying principle is that the NHS will work better if it operates on competition between healthcare providers, both existing NHS hospitals and clinics, and private and charitable hospitals and clinics which will have new access to NHS patients and cash.
Both Sky and the BBC have been telling us all day that competition drives up efficiency and quality.
But this is not true. If financial profit is the motive, then competition does indeed increase efficiency, in terms of maximising profit by minimising costs. But the natural tendency is for this to be at the expense of quality, except in certain specific areas of luxury good provision. Competition and profit drives the producer to give just as much quality as required to provide something the consumer will still take, while undercutting rival sellers. Where there are a limited number of providers, (and in most parts of the country there are obvious limits to the number of possible clinics and hospitals), this increasingly becomes a race to the bottom in quality, with the added temptaitons of cartelisation on price.
The NHS Future Forum has acknowledged that the real fears of patients and health professionals about the proposed NHS reforms were in many instances totally justified, says the CSP.
Reacting to the publication today by the forum of its consultation, chief executive Phil Gray said: ‘While we welcome some of the recommendations in Professor Field’s report, the CSP remains deeply concerned at the continued emphasis on increasing competition and a diversity of providers in the NHS, which physiotherapists believe will fragment patient care and lead to rationing. Increasing evidence is emerging of rationing on the basis of cost as opposed to clinical need.
The CSP was ‘very disappointed’ that – apart from the recommended changes to Monitor’s role – the forum’s proposals increase the potential for Any Qualified Provider policy.
Mr Gray said: ‘We believe this can only have a negative impact on patient care. We are receiving worrying reports from physiotherapists working under an AQP model who are concerned about severe rationing of their services leading to poorer patient outcomes.’
The CSP urges the government to halt the roll out of the AQP until the further work recommended by the NHS Future Forum on choice and competition and the risks of “cherry-picking” is complete.
Responding to the NHS Future Forum’s recommendations to the government on NHS reform in England, Dr Hamish Meldrum, Chairman of BMA Council, said:
“The way the government and the Future Forum have engaged with the profession during this listening exercise has been a refreshing experience. It is vital that this constructive approach is maintained in the following months as the detail is worked on.
“The Future Forum’s recommendations address many of the BMA’s key concerns, to a greater or lesser extent. We are hopeful that our ‘missing’ concerns, such as the excessive power of the NHS Commissioning Board over consortia and the so called ‘quality premium’ will be addressed as more detail emerges. While we welcome the acknowledgement that the education and training reforms need much more thinking through, there needs to be immediate action to prevent the imminent implosion of deaneries.
“Obviously, the critical factor is now how the government responds, as well as ensuring that the detail of the changes matches up to expectations. But if the government does accept the recommendations we have heard today we will be seeing, at the least, a dramatically different Health and Social Care Bill and one that would get us onto a much better track. There will then still be plenty more to do to ensure that the amended reforms do support the NHS and its staff in continuing to improve care for patients and tackle the major financial challenges ahead.”
Health experts welcomed today’s report but unions said the “NHS privatisation programme is still on track”.
Chris Ham, chief executive of the King’s Fund, said the recommendations would “significantly improve” the Health and Social Care Bill.
“The emphasis on integration is particularly significant and addresses a key weakness in the Government’s original proposals.
“The ‘pause’ has served the NHS, its staff and patients well by allowing time to reflect on how to deliver the reforms the health system needs. But it is now time to move on.
“The Government must now move quickly to endorse today’s report, put an end to the disagreements that have dominated recent months and provide the direction and stability the NHS desperately needs to navigate the challenging times ahead.
“Despite the headlines generated by the reforms, the key priority facing the NHS remains the need to find up to £20 billion in productivity improvements to maintain quality and avoid significant cuts in services.
Unite national officer for health, Rachael Maskell said the Bill should be scrapped.
She added: “The problem with Monitor is that it will now promote choice, competition and collaboration – all of which are contradictory aims.
“The hybrid mess that Monitor will become will do to the NHS what other botched regulatory bodies have done to other public services – from rail to social care.
“Unless patient care comes first, then Monitor will fail patients – and our politicians will have failed them too.”
She added: “”The way that David Cameron and Health Secretary Andrew Lansley will interpret the Future Forum’s recommendations is that the pace of the privatisation of the NHS will be slowed down, but not abandoned – that’s the crux.”
Dave Prentis, general secretary of Unison, said: “Really big questions over critical issues such as privatisation remain unanswered: just how will the Government prevent “cherry-picking”?
“And why are there no limits on the amount and range of services that can be privatised?
“The Forum is recommending sweeping changes to the Bill because it is riddled with flaws.
“It exposes the real agenda behind the Government’s Bill – the wholesale marketisation of the NHS.
“It wants to turn our health service into nothing more than a logo on the side of a van run by a multinational company.”
The NHS privatisation programme is still on track despite protests by health professionals to the Future Forum ‘listening’ exercise, Unite, the largest union in the country, said today (Monday 13 June).
Unite, which has 100,000 members in the health service, said that the NHS had been through an unprecedented year of uncertainty – but the report of the Future Forum, unveiled today, will do nothing to quell the concern of health professionals and patients.
It has been a wasted year that has caused havoc with the NHS which had just received its best patient satisfaction survey for a generation.
Unite said that the Future Forum had done some good work in exposing the flaws in the controversial Health and Social Care bill, but the pace of privatisation had only been slowed, not discarded – which will not meet the concerns expressed by the Liberal Democrats at their spring conference.
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