West Berkshire & North Hampshire

By Dr Richard Rudgley

We are all aware that the NHS is being reformed but there is a great deal of misunderstanding about how these changes will affect us. The change is so momentous we have to rely on trusting our politicians and those who are managing these changes.

The NHS has gone through several evolutionary developments since its inception in 1948. One major change was introduced by Margaret Thatcher’s government which brought in the purchaser/provider split in an attempt to introduce competition. For the first time all health care activities (for example a hip replacement) had to be priced and then the hospitals (the provider) could charge the purchaser (the health authorities).

The main driver for the new changes as introduced by the Health Secretary Andrew Lansley appears to be a financial one. An ageing population and new medical advances mean that health care inflation is higher than the background rate. To simplify, something needs to be done to control costs but without having an impact on the quality of care.

The Health Care Bill
The general aim of the new Health Care Bill is to replace the current purchasers of health care – Primary Care Trusts with GP consortia or clinical commissioning groups who will be in charge of buying health care. These groups will have a mix of members but will be largely led by local GPs who can choose to purchase from a range of public and private providers who are able to offer different prices.

In effect the NHS will be replaced with a market of competing health service providers. They will be overseen by a new health regulator, just like other areas of our national life such as the water and energy industries.

The government claim that many benefits will arise; management will be reduced and real competition will improve quality and reduce costs even further. They hope decisions will be made locally by GPS who understand what their patients need and there will be closer working with local authorities and public health bodies who can advise on local needs.

Criticisms
Critics include the BMA and the GP/midwife and nursing professional bodies, who have all come out against the bill arguing that this is revolution not evolution. They worry that it will cause damaging disruption, fragmentation of services and will eventually destabilise the health service. They suggest possible scenarios such as hospital closures and alienation of health care staff as their terms and conditions are continually changed which has already happened in the local government sector.

There is great pressure on the government to stop this new health care bill as it is felt that the reforms are going too far and too fast. However, planning for the new changes is in progress across the country with transitional arrangements and GP commissioning groups already in place in most areas. It seems likely that these changes will take place and will be implemented in April 2013.

Interesting times lie ahead, watch this space!