Reforming the NHS

Last week, health secretary Andrew Lansley unveiled his ‘radical’ new proposals for the NHS, outlining changes which many commentators have hailed as the most revolutionary since it’s inception in 1948.

The reforms aim to rid the health service from the tyranny of "unnecessary" bureaucracy by outlining a vision for an NHS led not by politicians, but by patients and healthcare professionals. The restructuring will see the dissolution of strategic health authorities and primary care trusts (which at present manage the majority of the NHS budget) with GPs across the country becoming responsible for managing a sizable £80bn NHS budget. Ministers hope that the new system will reduce bureaucracy and give doctors and patients more control over treatment, whilst also helping to reduce management costs by up to 45% (the NHS is tasked with making some £20bn savings by 2014).

At the heart of the reforms are GPs, which Lansley believes are better placed to make decisions than managers. Through the creation of some 500 GP consortia, the new plans will see GPs working together to select and commission the NHS services their patients need. Each local GP consortium will take charge of local hospital, mental health and community services (specialist services and dentistry excluded), whilst local authorities will take control of public health. The GP consortia will in turn be held accountable by the formation of an independent NHS board which will be responsible for setting standards across the country. Hospitals are to be moved outside of the NHS and are to be turned into freestanding ‘social enterprises’. The gradual phasing out of the 10 strategic health authorities and 150 primary care trusts will occur over the next 4 years as GPs begin to take control of their managerial responsibilities.

Patient empowerment is also at the core of the shake-up, with an aim to give them more involvement within the decisions that affect how and where they are treated. The freedom to choose is also provided, with the abolishment of GP boundaries, allowing patients to register with any doctor they want. A new body called Health Watch England is also to be set up to help ‘strengthen the voice of patients’ and to share information on the performance of local health services.

The inevitable impact on those working within NHS administrative roles is obvious; thousands of jobs will be lost. There are also concerns over whether GPs have the time or necessary skills to discharge their new responsibilities effectively. It is expected that GPs will have to outsource; commissioning support from private firms, which many believe would do little to reduce spending. It has also been announced that £1.7bn will be set aside for the reorganisation – more than seven times what it aims to save on management.

The public sector union Unison has warned that the proposals were “a recipe for more privatisation and less stability”. It is perhaps this concern of ‘denationalisation’ with the expansion of private firms’ involvement within the NHS which appears to have produced the greatest controversy. Opponents have already pointed towards the ‘conspiracy’ to privatise the NHS, predicting an environment of conflicting interests, where patient needs ultimately fall foul to profit margins.

Nonetheless, we are living in an economic environment which can no longer support the NHS as it stands. The British Medical Association’s response to the restructure, reflected positively in agreement, stating that ‘doctors are ideally placed to help determine the health needs of their local population’. These changes, whilst representing a significant gamble, do offer the potential for savings whilst maintaining a quality health service.

It is clear that the government now has two major hurdles to overcome as the new plans are rolled out over the coming years. Firstly, the restructuring must be carried out efficiently and in consultation with GPs so as to avoid any needless disruption to frontline services. Secondly, and perhaps more importantly, these reforms must bring about the improvements we have been promised they will provide. The future of our national health service now rests delicately in the hands of the coalition Government and it's health reforms. Fingers crossed.