by René Lavanchy
PLANS to give National Health Service patients cash to pick and choose their own treatment, together with the new NHS constitution, have drawn criticism from patients’ groups and unions this week.
Ministers say that the constitution will hand power from doctors to patients by telling them their rights to treatment and information, as well as their responsibilities, in one document. Signed by Gordon Brown and NHS chief executive David Nicholson this week, it will take effect once the Health Bill becomes law.
But the Patients’ Association said the constitution would make no difference to the quality of healthcare, while Unison has attacked measures in the bill to create personal budgets controlled by patients, saying it may lead to an “Oliver Twist” scenario of patients asking for more.
The Department of Health will this year launch pilot programmes to test different types of patient budget. Under the most radical proposal, patients will be given cash payments and be expected to manage the different staff serving them.
The chosen budget system will then be applied nationwide using a statutory instrument, which is normally rubber-stamped by Parliament. Details of the pilots have not yet been announced, and it is unknown how much of the NHS’ £100 billion budget will be used.
Karen Jennings, Unison’s head of health, said: “There is a world of difference between giving patients greater say over their treatment, which we support, and giving them money to buy in their own healthcare. Choosing the most effective treatment from a range of options is not an easy decision for patients”.
“We are in real danger of creating a situation where patients use their personal budget ineffectively and then, like Oliver Twist, go back for more. Or, patients will be persuaded to top up their budgets from their own savings, undermining the very founding principle of free healthcare for all.”
The bill also extends the powers of ministers to suspend failing NHS trusts by installing “special administrators” in their place.
Unite said they supported the bill’s commitment to greater accountability, but wanted more detail about personal budgets. National officer for health Karen Reay said: “There’s so many checks and balances you would need to ensure they were used appropriately. How do you then plan for the future services? You have no idea what people will spend their budgets on.”
The union has meanwhile complained about a clause in the NHS constitution which appears to commit the Government to privatisation. The “principles that guide the NHS” section commits the NHS to working with “a wide range of other private, public and third sector organisations at national and local level to provide and deliver improvements in health and well-being.”
The constitution states for the first time that patients have a legal right to drugs approved by the National Institute for Clinical Excellence, even if their hospital refuses to prescribe them. Other rights, such as free healthcare except in limited cases, are more familiar.
Patients’ Association director Katherine Murphy said: “We do not expect this document to make any difference to the care patients are receiving… For the NHS constitution to be effective, trusts need to do more than ‘have regard’ to it. The time for NHS management to manage as if their jobs depended on it is long overdue.”
