How did it all go so wrong? David Cameron must have asked himself that question this week when he was forced yet again to attempt to rescue his Government’s plans to restructure the National Health Service.Increasing criticism and controversy had already forced him to delay the proposals and promise a rethink – “to pause, listen, reflect and improve on plans for reforming the NHS”. Growing condemnation and disapproval led him to set up the NHS Future Forum, a panel of health professionals, patients and public representatives to “listen and advise” on the changes.
Now, in a last-ditch attempt to win round detractors, the Prime Minister has been forced to make a widely leaked, highly publicised and allegedly heartfelt “how I love the NHS” speech, insisting that he and his party will save the NHS by changing it because “it needs to change to avoid a crisis tomorrow”. But will this convince the critics? Will it silence his Liberal Democrat coalition partners who are increasingly angered at many of the hard-line proposals?
Andrew Lansley’s Health and Social Care Bill is proving a major disaster zone for the Government – a debacle ministers surely did not envisage and one they could certainly do without.The storm over the changes, particularly the encouragement of greater competition with the private sector, has gained pace at a tremendous rate. Nurses, doctors and health service managers have attacked the sweeping shake-up.
Even Steve Field, the GP appointed by Cameron to head the NHS Future Forum has said it could “destabilise” the health service. He warned that the decision to “enforce competition between healthcare providers” should be scrapped and replaced with an obligation to “promote co-operation and collaboration and integration of health services.”
Isn’t that obvious? Not to Lansley, it appears. According to him: “We are using the benefits of competition to deliver a public service”. The latest attack has come from nhsManagers.com, a website run by Roy Lilley, founder member of the NHS Trust Federation and a renowned healthcare expert. A poll of nearly 5,000 managers showed that 98 per cent thought the bill was “irrelevant” and “dangerous”. They, like many working in the NHS, say that changes and improvements are needed, but “all the objectives can be achieved without the need for the disruptive Health Bill”.
They are concerned at the involvement of private sector companies in the health service and the fact that GPs do not have the competencies to take on responsibility for health commissioning. There are no doubts that GPs know what their patients want, understand their needs and are best placed to appreciate where the money should be spent. They should play an essential role in the process of commissioning healthcare. But they should not be in sole charge of it.
No one will disagree with Cameron that the postcode lottery, is unfair. But handing commissioning to GPs is not going to end that. There will still be GPs in one postcode who will commission certain care for patients, while others in a different postcode do not.
No one will disagree when Cameron says he wants to improve cancer and respiratory disease survival rates so that Britain is closer to its European neighbours. His changes are not going to ensure that either.Cameron is right when he says the Government does not do “anyone any favours if we deny there are problems with the way the NHS works today”. Politicians from every party and everyone working in the health service can see that.
But Lansley’s extreme and uncompromising changes are not the way to address these problems. They are simply lengthening the dividing line between the Government and the NHS – a dividing line that can never be broken while Lansley is in charge of our health service.
