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The Health and Social Care Bill 2011 will bring on something of a revolution in the NHS – the biggest change since it was established in 1948 – and these developments will all take place in a landscape of enormous financial challenge. The NHS needs to deliver unprecedented productivity gains over the next few years. Many of the changes, such as enhancing the role of local authorities in the health system, giving health-care providers greater autonomy, and radically reforming commissioning to further involve GPs, have the potential to improve care for patients and to enhance the performance of the NHS.
However, the Bill will also introduce a step change in implementing market-based principles in the health system, with the aim of improving diversity of supply, promoting competition, and increasing choice for patients. While the NHS needs to change, if the scale of change is too big, and the speed too fast, its performance during the transition could be affected unfavourably, disadvantaging patients instead of improving their care and their life chances.
Contributors to this supplement consider how increasing competition in the NHS will affect us. We look at the relationship between citizens and the state and whether the original NHS values can be refounded within this new, broader agenda. How much choice will we actially have and how much influence over our health care? What if, collectively, we make poor choices? Services that are competing against each other will also be required to work together and integrate. How will that work and who will advise us and regulate all of this?
FIrst published December 2011,
After much delay and anticipation, the government’s Open Public Services white paper, published in July 2011, sets out how it intends to improve and modernise our public services. By “putting choice and control in the hands of individuals and neighbourhoods”, it believes it can make public services more responsive to people’s needs. It is applying five key principles: increased choice; decentralising power to the “lowest appropriate level”; diversity – public services should be open to a range of providers; fair access to services; accountability – our public services should be accountable to service users and taxpayers.
It all sounds like something we might be able to sign up to. However, choice requires that people are informed in a way that they understand and can use to bring about positive benefits for themselves. Choice needs to be genuine rather than simply a variety of providers offering the same services. And if we are having diversity, will all choices be available to all people in all areas? Will people be able to buy in services from their neighbouring local authority if what they want isn’t offered in their area?
Charities will be given more opportunities to bid for government money. Trustees and charity managers will have to make some careful decisions. However, are charities ready to deliver the types of public services that government wants and the public needs? While many are already having success, others will not have the skills, experience or capital to do the job at the scale that is being asked of them.
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First published 09 January 2012
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