NHS Reform - February 2011

Many constituents have emailed me to express concern about what they have heard about the Government’s NHS reforms.  There is often a great difference between what one can hear on the broadcast media and what is actually happening.  Over the last decade, the most persistent complaint people have raised has been the way they perceive that NHS management has grown exponentially. Actually I think the managers get a bad press, if you are spending billions it has to be managed.  People are right, however, the organisation has become far too bureaucratic.  It responds to management priorities and to the orders of the political masters that drive them, rather than -as it ought-to the decisions of doctors and to needs of patients. 

  It is for this reason that the coalition government is acting to remove two complete layers of management which sit between the patient’s family doctor and the hospitals or other service providers.  We will abolish health authorities and primary care trusts.  Instead, groups of family doctors will come together into consortia which will control 80% of the NHS budget to pay for the treatment of their patients.  It will be the commissioning decisions of these groupings of general practitioners, on behalf of their patients, that will determine the shape of NHS services.  Treatments they prescribe will thrive, treatments they don’t, won’t.  Hospitals they prefer will do well and expand whilst hospitals they avoid will contract or even close. 

  There are two things to beware of.  First, ministers will have to work very hard indeed to restrain the growth of a new bureaucracy in support of the GP commissioning consortia.  Of course, they will need managers but we do not want to see the bureaucracy that we have scrapped migrating over to a new home.  Second, because the decisions of family doctors will drive the services provided and not provided by the rest of the NHS,  no longer will politicians call the shots.  Are we politically mature enough to accept this?  If hospitals close because GPs simply won’t send their patients there, will we accept the decision or will we mount campaigns to try and force politicians to intervene?  I have done exactly that in the past, but my excuse is that the decisions to which I was objecting had been made by bureaucrats who are not accountable to patients.  I would be much more reluctant to do so if it was the consequence of decisions by family doctors on behalf of their patients.

 What is absolutely certain is that the NHS cannot afford to stand still:  new and more expensive treatments are being discovered all the time and the drugs bill is increasing by £500million per year.  Also, as the proportion of elderly people increases, so the demand for NHS services increases too.  Even though we have guaranteed real increases in health expenditure every year, we can only afford to go on providing more services if we make them cost effective and more efficient.  Redundant capacity and buildings, however we may have become sentimentally attached to them, will have to be abandoned if we are not making proper use of them. These are decisions that need to be driven by medical priorities. When, in the past, it would have been a decision for managers, or even worse, for politicians to make.