Leader: Yet more top-down prescriptions for the NHS

There is no evidence that GPs want this responsibility or have the skills to fulfil the task.

By Staff blogger Published 15 July 2010

In his first address to the Conservative conference as leader four years ago, David Cameron noted that while it took Tony Blair three words to sum up his priorities for government ("Education, education, education"), he could do it in three letters: "N-H-S". There is little doubt that Mr Cameron has great admiration, approaching awe, for the men and women who work for and in the National Health Service; his attachment is especially strong because of the care and support given to his late son, Ivan, during his struggles with illness and disability. It is all the more curious, therefore, that he has sanctioned his Health Secretary, Andrew Lansley, to propose a raft of changes to the NHS within the first 100 days of the coalition government. These changes represent not just bad policy, but bad politics.

Mr Lansley's plans - detailed in a white paper presented to the House on 12 July - would result in the abolition of England's ten strategic health authorities and 152 primary care trusts (PCTs). In their place the country's 56,000 GPs would be expected to form roughly 500 consortiums responsible for an £80bn care budget, the vast proportion of NHS spend. The ambition is to have all this in place in 2013.

This is bad politics because it is an unnecessary risk. The coalition is already committed to real-term increases in NHS spending - a legacy of a Tory pre-election promise that also looks increasingly unsustainable when other Whitehall departments are facing cuts of up to 40 per cent. So why embark on yet another major reorganisation? At that 2006 party conference, Mr Cameron promised that there would be "no more pointless reorganisations", and the coalition agreement, reached less than two months ago, pledged to "stop the top-down reorganisations of the NHS".

Yet make no mistake; in spite of the rhetoric, this is another top-down reorganisation of England's health service. It is deeply flawed. For a start, there is no evidence that the bureaucratic load would diminish. Health authorities and PCTs would be replaced by the NHS Commissioning Board and the GPs' consortiums: in effect, two decision-making bodies separating the Department of Health from providers of care would be replaced by . . . two more tiers of management.

Moreover, the proposed regime introduces a potential conflict of interest. General practitioners would become both service provider and service purchaser. As with Michael Gove's plans for the introduction of free schools, the ideological drive for less management is not matched by guarantees of accountability or specific funding commitments. Mr Cameron's coalition partners in the Liberal Democrats wanted to give patients a stronger voice by introducing elections to primary care trusts. That idea has gone the way of the PCTs themselves.

Further, there is no evidence that GPs want this responsibility or have the skills to fulfil the task. "I can't read a balance sheet," one GP wrote in the week Mr Lansley announced his plans. Undoubtedly she is not alone. If GPs lack the desire or the expertise to operate in this way, the gap would inevitably be filled by private firms. No wonder there is talk of "denationalisation". These reforms would result in unnecessary, unwanted and creeping privatisation of our health service.

If this is a cost-saving exercise, there is no guarantee that it would be a cheaper alternative - quite the reverse, in fact. Civitas, a think tank with solid right-of-centre credentials, warned that the proposals represent a "huge structural change" and come at significant cost. Calculations by the Health Service Journal suggest the new model could cost £1.2bn more than the current one.

Andy Burnham, Mr Lansley's predecessor and his current shadow, was entirely correct when he characterised the overall package as "a giant political experiment with no consultation, no piloting, no evidence". Or, to steal the words of Mr Cameron, a pointless reorganisation

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View the discussion thread.

4 comments

Thu, 2010-07-15 04:04 — CrISpY DuCk

Firstly I can't believe this is tucked away as a secondary article when I believe the whole future of the NHS is at stake.
They tell us the bobby's on the beat can't do their job's properly because of the paperwork and yet they're burdening GP's with the same.I find it ironic that the people from the PCT's will be required to train the private sector to do their own job's.It's driven by political idiology and in effect is the privitisation of a huge chunk of the NHS.

Labour MP for Oldham West and Royton

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The NHS, Labour’s last redoubt, under siege
July 10th, 2010

The Tory NHS plan, to be unveiled on Monday in a White Paper, is essentially the next corporatist stage in the dismantling of the founding NHS principles of efficiency, integration, universality, and careful need-based planning. The original commercialisation of the NHS was initiated by New Labour under Blair with the establishment of independent foundation trusts, the continuation of the Tory split between the commissioning and provision of health care, the marketising of specific NHS services, and the encouragement of the private sector through independent treatment centres and other subsidised schemes.

The issue now is whether any political party is sufficiently committed to the genuine principles of the NHS to rally a massive campaign to fight vigorously for them, given that Labour has been so deeply compromised by the Blair years. For nothing less is at issue than whether a universal health care system free at the point of use is going to survive.

The key point in the Lansley Tory proposals is that power will be transferred in the NHS from primary care trusts to some 500 GP consortia who will be given £80bn of public money each year to commission the health provision they want. But because the vast majority of GPs have neither the expertise, the skills or the inclination to undertake this enormous administrative task, they will hand it over to private providers such as BUPA, Virgin or US multinational corporations such as UnitedHealth to parcel out health care to the private sector on a vast scale.

It’s dragging down the NHS towards a US-type health care system, and it’s not as though there is any evidence-based case to support this. The US health system is the most inefficient in the Western world, costing a staggering 16% of US GDP (twice the proportionate share of the UK), it is riddled with conflicts of interest, it denies health care to millions of excluded patients even after the Obama reforms, and it gives inordinate power and colossal profits to the insurance and hospital industries. It does however provide instant state-of-the-art health care for the extremely wealthy. That is the path for health care now being opened up in Britain.

It isn’t enough simply to resist this US-style disaster. New Labour had already encouraged PCTs to use private sector management consultants and for-profit healthcare companies to help them develop ‘commissioning’ skills. Lansley will certainly portray his “reforms” as merely an extension of these practices. The real question now is: is Labour going to present a new radical vision of an integrated, efficient NHS driven by a public ethos of altruism and professionalism or simply mumble objections that the Lansley proposals are a step too far?

Tue, 2010-07-20 16:55 — coffeetime (not verified)

what really bothers me is that there wasn't a HINT of this anywhere during the Election Campaign...not on the doorstep,not in the TV debates,not in articles Nowhere!

why not?

because they knew it would be immensely unpopular and lose them votes.

Now this is not some piffling minor tweaking..it is a massive turnaround which has private health companies chomping at the bit.

So not to tell us what they were planning was dishonest. No other word for it.

Fri, 2010-07-16 22:22 — Alex4

" There is little doubt that Mr Cameron has great admiration, approaching awe, for the men and women who work for and in the National Health Service; his attachment is especially strong because of the care and support given to his late son, Ivan, during his struggles with illness and disability. "

I think Cameron gets too much credit for his "support" of the NHS based on his experience of his son's treatment.

What if his son had not been chronically ill? Would he have had the imagination and empathy to understand the need for and the value of the NHS?

If not, as I suspect, he would just be another rich privileged anti-NHS Tory. Like most of his cabimet.

Sun, 2010-07-18 23:01 — goonergirl

It all sounds so simple. I doubt the GPs will want to manage over 100 statutory responsibilities currently undertaken by each of the SHAs.Not without still more money because as we know they are private entrepreneurs...
Having spent recent months peddling theelectioneering myth that NHS managers are all rubbish (and by the way NHS Managers include all the Occupational therapists, physios and nurses above basic grade), why would those managers feel inclined to stay in an NHS which does not value their efforts and which does not offer employee share ownership and other benefits enjoyed by private sector managers (who outnumber NHS managers in every organisation)?