Unless you’ve been living in a cave for the last few years you can’t have failed to notice that the coalition Government has been planning how to restructure the NHS in England. Those with long memories will remember that this goes directly against the Conservative’s election campaign pledge poster (below).
However, there’s been very little real in depth press coverage of these changes. Indeed some NHS campaign groups have accused the Government of creating a media black out on the topic.
So we thought that as the Government’s NHS reforms in England come into force today it would be useful to give you a simple run down of the changes, as each and everyone of us will be touched by the changes in some way.
Why are NHS changes being made?
The simple fact is that NHS costs are rising at a much higher rate than inflation. This is due to factors such as our aging population, the high costs of new drugs and treatments and lifestyle factor costs such as treating obesity. The Government argues that without radical changes services would have to be greatly rationed in future.
What you need to know…
1) GP-led groups (called CCGs, Commissioning Care Groups) have now taken control of local budgets
This means that CCGs (led by GPs) will decide on how funds will be spent on local health services from hospitals to community based clinics in England. There will be 211 of these groups and they replace the role previously provided by the PCTs (Primary Care Trusts).
“CCGs will be the new rationers of care. This concerns doctors because they are very uncomfortable with having to take rationing decisions,” Porter said. “The General Medical Council’s ‘duties of a doctor’ says the first one is to make the care of your patient your first concern, and we’re being dragged away from that.” Dr Mark Porter, Guardian, Monday 1 April 2013
Pros: GPs are closer to their patients & their services that those civil servants in Ivory towers
Cons: Few GPs have the additional time or training to manage these changes, many have stated in the media that their hands are tied as they have to follow Government cuts. The perception is that they will have freedom as to how budgets are spent, the reality is…yet to be discovered
2) A new board, NHS England, will oversee the day-to-day running of health services
SHAs (Strategic Health Authorities) which previously provided oversight of services are being scrapped. Instead that job will be done instead by the NHS Commissioning Board, headed by Sir David Nicholson. This board will be responsible for special budgets and services e.g. complex surgery, rare cancers and areas like dentistry.
Pros: this may create more joined up thinking
Cons: does it add another layer of bureaucracy to an already complicated organisation?
3) 152 primary care trusts are scrapped
Pros: will the new NHS England board ensure greater consistency and communication across regions, helping eradicate post code lottery decisions?
Cons: will it make it harder for local people to have a body to complain to and have transparency and clarity on what is happening to health services in their local area?
4) Private companies now make up more of the NHS
To date just 3.5% of elective operations like hip and knee ops were done by the private sector. This is set to rise under the new regime.
Pros: will this make access to treatment simpler, quicker and more efficient?
Cons: or will this mean that private companies will simply cherry pick services and treatments that they want to offer - which are the most profitable for them? Will we find that some vital services not profitable and so waiting lists are extended? Will there be pressure for GPs to use private providers to ‘save costs’? Is this the start of a slippery slope that will slowly erode the very nature of the public NHS?
5) Your local Council will now have a key role
Councils will run public health services. This will include everything from obesity reduction programmes, stop smoking services to healthy lifestyle promotions. Of course local government has already been playing a role in these areas - often through partnerships with primary care trusts. They have been given a budget of £3bn a year.
Pros: the new thinking behind these changes is that councils will have powers over things such as schools to leisure services.
Cons: this means that local Councils will have huge power over how we live our lives. Many of us already have individual gripes with how our councils run local services like litter collection and road maintenance. Do we trust them to more efficient with our healthcare?
Will you notice a big difference in health services?
Yes & No.
Over the next few weeks your local GP surgery and hospital will probably look and act the same as it did before the changes came into effect.
But…over the next few months and years the changes will influence our health service in the most radical way ever.
Some of the most expensive diseases for the NHS to manage are heart disease, diabetes and dementia. There’s no magic cure for these diseases. The NHS needs to consider how to manage patients effectively with these long term diseases in the most cost effective way, whilst meeting their individual needs so that they can continue to live healthy and balanced lives. Currently many hospital A&E beds are taken up by people with life long diseases and problems associated with old age. We know we live in an aging population so the strains upon the NHS will continue to grow. Perhaps some of the NHS reforms will enable a greater range of community services to bridge this gap between GP and hospital health care? Or will we see a rise in Private Health care provision for services which are most profitable and less integrated care for long term non profitable conditions?
What do you think?
Love or loathe the new NHS reforms?
Do you think that Coeliac services will be cut? Will there be even less prescription food available? Will Coeliac check-ups be cut (from our past surveys it seems like only a tiny minority of you actually have annual check-ups anyway)? Or do you embrace the changes? Would you like to see the NHS fully privatised? Or do you fear that we’ll end up like the USA with a two tier healthcare system i.e. for those that can afford to pay for it versus the poor who cannot?
Do these changes alter the very ethos of Bevan’s original aims for the NHS?