Lansley’s NHS reforms will undermine fairness

Another organisational shake-up does not surprise doctors, but this is a much bolder move towards pr

Andrew Lansley has launched a white paper that has been heralded as the biggest shake-up of the NHS in a generation.

The key proposals are:

  • Abolishing ten strategic health authorities by 2012 and scrapping the 152 primary care trusts by 2013. This would mean that up to 30,000 managers face being cut or redeployed.
  • Replacing these management structures with about 500 GP "consortiums" (not optional), meaning that family doctors will have control of £80bn of public money.
  • Allowing hospitals to leave public ownership to become "not-for-profit" companies.

The first thing to note is that the NHS has been in a state of almost continuous reform for nearly three decades. There has been some form of organisational change almost every year since the early 1990s. Many of these changes resemble each other; 2002's primary care trusts were difficult to distinguish from 1982's district health authorities. The same goes for NHS trusts and foundation hospitals.

The cumulative effect -- apart from the fact that most new structures don't have time to show positive effects before they are changed again -- is cynicism in the medical profession, as evident in this doctor's blog:

As the ministers and commentators observe the effects of their "bold vision" and "strategic planning", I am happy to tell them how much difference this will make to most Jobbing Doctors -- very little. You see, we have seen this all before.

Under the internal market established by Margaret Thatcher, and not-much-changed by Tony Blair, GPs surgeries already operate much like private businesses that commission services from hospitals. Equally, under private finance initiatives, private companies have been involved in building numerous new hospitals.

But what the new plans do amount to is a much bolder and more open step towards privatisation of the National Health Service. As with so many of the coalition's reforms, the move towards less bureaucracy is not matched by guarantees of accountability, which are needed to maintain a consistent standard countrywide.

Oddly enough, Melanie Phillips makes a good point about this:

It also surely runs the risk of fragmenting the service, since GPs will try to look after their own clinical patch rather than the general good. And this gets to the crux of the problem. A national service needs to offer unified provision throughout the country in order to be seen to be equitable.

Yesterday, Lansley spoke of the need for competition and choice, echoing Thatcher's market ideology, ignoring that last time this was implemented, we were left with a hugely unfair postcode lottery. Lest we forget, the much-reviled target culture did produce results, with waiting list figures, among others, drastically improved (LabourList has some numbers here).

The NHS was founded on the principle of fairness. Let's not undermine that by restructuring the system in such a way that it has no mechanisms to help that fairness flourish.

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Samira Shackle is a freelance journalist, who tweets @samirashackle. She was formerly a staff writer for the New Statesman.

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David Cameron calls Sadiq Khan a “proud Muslim” – after trying to link him to Islamic extremism

The PM has his best flipflops on.

After months of backing the nasty racial politics of the Tory mayoral campaign, the Prime Minister has taken the bold move of sharing a platform with infamous moderate Sadiq Khan on the EU Remain campaign trail. Quite a spectacular about-turn.

Compare and contrast, readers.

David Cameron, 20 April 2016

“If we are going to condemn not just violent extremism, but also the extremism that seeks to justify violence in any way, it is very important that we do not back these people, and we do not appear on platforms with them. And I have to say, I am concerned about Labour’s candidate for Mayor of London, who has appeared again and again and again . . . The Honourable Member for Tooting has appeared on a platform with him [imam Suliman Gani] nine times. This man supports IS.”

David Cameron, 30 May 2016

“Let me first of all congratulate Sadiq on his victory. He talked about his father. He’s the son of a bus driver. I’m the son of a stockbroker, which is not quite so romantic. But he makes an important point about our country. In one generation someone who’s a proud Muslim, a proud Brit and a proud Londoner can become mayor of the greatest city on Earth. That says something about our country. There are still glass ceilings we have got to smash. There’s still discrimination we have got to fight.”

What a difference a month makes, eh?

I'm a mole, innit.