And what about the NHS anyway?

Politicians ‘raising their legs’ at it

Dr Jacky Davis opened this part of the discussion with an often wry run-down of the proposed health reforms and what they’ll mean for both patients and doctors. After 15 reorganisations in 30 years, she described the attraction for meddling with the NHS like ‘a tree every politician has to raise his leg against’. Before the election Lansley had promised ‘no major reforms’ to the NHS and then only a few weeks after came out with the White Paper. She acknowledged the problems with the PCTs like we’ve had, and the way hospital trusts are set against GPs but at the moment the alternative seems to be the ‘entire break-up of the NHS’.

Dr Davis said that the logical fault in the proposed reforms is the promise to encourage co-operation between different health care providers while mandating market competition between them. There is also a lack of any clear structure for collecting and evaluating public health statistics, nor any guidance about who exactly is to be on the over-arching ‘independent’ NHS Commissioning Board. The vaunted GP consortia will be answerable to the NHS Commissioning Board about its decisions, plus the board will also make its own commissioning decisions about the great swathe of services which are not to be commissioned by GPs, like maternity and other specialist services.

If GPs want to continue also treating patients they will have to hire in some kind of management expertise and structure – this could be private US healthcare companies or possibly some conglomeration of former PCT execs, in a social enterprise. The important thing for patients is that employees of the former NHS services, forced into self-managed not-for-profits or absorbed into multi-national providers, will now be bidding for contracts without preference. There is also much evidence from the US that this kind of competition in health services drives up costs without necessarily adding to the quality or range coverage.

The other major problem with the reforms is the removal of health services from public accountability – despite the four ‘tests’ including public consultation laid out for any public health decision, GPs are not directly accountable to the government, and it is very unclear how accountable the NHS Commissioning Board will be. Also “commercial confidentiality” may well preclude public scrutiny of accounts or tenders.

Lively discussion

The chair pointed out that one of the photos flashed up was the Finsbury Borough Council which had agreed to the funding and design of FHC – with the advice of a Medical Officer of Health, who was responsible for collecting public health statistics and information about what migh improve it. The work of these public servants, first in London and the cities and then throughout the UK, was largely responsible for making the case for  the NHS after World War II. There is no reason why, properly advised and in touch themselves with local needs, that elected local representatives could not make reasonable decisions about providing or commissioning a public health services. The particular problem facing FHC is the white paper’s complete lack of any statement about who will own NHS property.

During a lively exchange between Dr Davis and Dr Peter Baines of the Clerkenwell Practice in FHC, they agreed that a large part of the problem is competition between hospital primary care and GP-led primary care already set up by the internal market. The proposals, which do not mention hospital doctors at all, are likely to make this situation worse. Dr Davis said that many GPs are against the proposals because they became doctors in order to treat patients, not become managers. Members of the audience asked many questions, and expressed strong support for keeping the NHS a national public service.

How to resist the proposals

A full set of consultation papers about the reforms is here, and the deadline for reponses seems to have been pushed back to 11 October. Keep Our NHS Public’s website has more information about the effects of the proposed reforms and initiatives against it. KONP is planning a major public meeting about the reforms soon. Dr Davis advised everyone to write to their MP. A member of the audience who works for a women’s magazine publisher suggested people go on any web forums they commonly use and discuss the issue, since many aren’t aware of the proposals or their potential to wipe out the NHS.

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