SPECIAL REPORT
Reforming the NHS in England Infinite Demands – Finite Resources GP Consortia and Management Reorganisation or Re-disorganisation? Bones of Contention The “Future Forum” Likely Amendments to Proposals Quality of Care and Vocation Will Reforms be Successful? Ensuring Free and Fair Healthcare for All
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SPECIAL REPORT: REFORMING THE NHS IN ENGLAND
SPECIAL REPORT
Reforming the NHS in England Infinite Demands – Finite Resources
Contents
GP Consortia and Management Reorganisation or Re-disorganisation? Bones of Contention The “Future Forum” Likely Amendments to Proposals Quality of Care and Vocation
REFORMING THE NHS IN ENGLAND
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By Leslie Paine
Will Reforms be Successful? Ensuring Free and Fair Healthcare for All
Infinite Demands – Finite Resources
3
GP Consortia and Management
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Reorganisation or Re-disorganisation?
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Bones of Contention
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The “Future Forum”
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Likely Amendments to Proposals
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Quality of Care and Vocation
5
Will Reforms be Successful?
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Ensuring Free and Fair Healthcare for All
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References
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Published by Global Business Media
Published by Global Business Media
Publisher Kevin Bell Business Development Director Marie-Anne Brooks Editor Martin Richards Senior Project Manager Steve Banks Advertising Executives Michael McCarthy Abigail Coombes Production Manager Paul Davies For further information visit: www.globalbusinessmedia.org The opinions and views expressed in the editorial content in this publication are those of the authors alone and do not necessarily represent the views of any organisation with which they may be associated. Material in advertisements and promotional features may be considered to represent the views of the advertisers and promoters. The views and opinions expressed in this publication do not necessarily express the views of the Publishers or the Editor. While every care has been taken in the preparation of this publication, neither the Publishers nor the Editor are responsible for such opinions and views or for any inaccuracies in the articles.
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SPECIAL REPORT: REFORMING THE NHS IN ENGLAND
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SPECIAL REPORT: REFORMING THE NHS IN ENGLAND
Reforming the NHS in England By Leslie Paine
Leslie Paine OBE, has worked in the NHS for 35 years and was a hospital Chief Executive for 25 years, at Addenbrookes in Cambridge and the Maudsley and Bethlem Royal in London.
Demonstrate and develop your management skills by joining the IHM’s
Infinite Demands – Finite Resources
Accredited Manager Programme The new arrangements will also need good
Demonstrate and develop
your management skills by
According to the Coalition Government, unless we do something about rising healthcare costs joining the IHM’s in England, the founding principle of the NHS – care that is free to all who need it when they need it – will become unaffordable(1). Sounds awful. Until you remember that the NHS has always been unaffordable. In the sense that finite resources (which it has) can never meet the infinite demands of disease and accident, no matter how hard you try, without the interjection of some form of priority-setting or rationing system. Something that the NHS has been doing since its inception and doing pretty well, particularly Join the programme and... The programme is fast over the last ten years according Anna Dixon, Director of Policy at the King’s Fund in London. becomingteam a nationally Enhance your CV and/or strengthen your management As she puts it in the Spring 2011 edition of the Demonstrate your commitment to the pursuitrecognised of excellence symbol of NAPC Review: “The NHS has made significant excellence in healthcare progress over the past decade (Thorlby and Maybin 2010) with some of the highest levels of which Ruth Spellman, the Chief Executive management across Chartered Management Institute, public satisfaction ever recorded (Appleby and of the Individuals join the programme every February, June October theorcountry estimates at 45%. Although, as she reminds Robertson 2011)”(2). Organisational cohorts can be bespoke to meet local need. Its budget of course has been considerably us, the new arrangements will also need Join the programme and For furtherand information, please increased down the years – 2.5% of Gross good management leadership, the key toemail education@ihm.org.uk Domestic Product in 1949, 8.5% today. But, which will the retention of thoseaccredited staff with The be programme will be academically Enhance your CV and/or strengthen in the Government’s view, that won’t work any good skills and the support of those with new your management team longer. “Just putting in a little money and carrying managerial responsibilities (3). Demonstrate your commitment But while we will all say amen to that, everyone on business as usual, is not good enough” the IHM poster.indd 1 16/5/11 10:16:19 to the persuit of excellence Prime Minister says. “Fail to modernise and the knows that patients come to doctors and hospitals to be treated not administered. To NHS is heading for crisis.”(1) patients, therefore, the managers are ‘enablers’. GP Consortia and Management They are not the men and women behind the Individuals join the programme And by modernisation of course he means at NHS guns, they are the men and women behind every February, June or October. the moment the abolition over the next two- them.’ And their basic jobs are to create and three years of all the existing Primary Care Trusts maintain the environment and facilities which Organisational cohorts can be and Strategic Health Authorities, and allow the front line troops – doctors, nurses, bespoke to meet local need. the transference of their commissioning therapists – to deploy their skills to the very best responsibilities (widened to include the of their abilities. possible employment of private providers) to a For further information, please Reorganisation or countrywide network of GP Consortia. email education@ihm.org.uk By this means and a demand for so-called Re-disorganisation? ‘efficiency savings’ in administrative costs of That said, what line should we take regarding the £15-20 billion by 2015, the Government aims to proposed reforms? How can we know whether The programme will be academically accredited achieve a cut in the number of NHS managers, the English NHS, altered as the Government
management and
Accredited to which will be is thefast becoming a The programme Manager nationally recognised symbol of excellence retention of those staff Programme in healthcare management with good skills and across the country leadership, the key
the support of those
with new managerial responsibilities.
WWW.PRIMARYCAREREPORTS.CO.UK | 3
SPECIAL REPORT: REFORMING THE NHS IN ENGLAND
Above all else though, the objection that is most common to the ranks of the doubters is that the reforms open the way to the privatisation of the NHS by stealth.
wishes, will give better value for money than the one it replaces? This is a subject on which everyone has an opinion but to which no-one has a complete answer. Proponents of the proposals presage their outcome as a world class health system. Opponents say they’ve heard it all before and suggest that it is more likely to result in re-disorganisation than reorganisation: a set of good intentions that will pave, as good intentions are said to do, yet another road that will lead somewhere far removed from heaven. The many doubters perched on the middle ground of the argument warn of ‘more haste, less speed,’ recommend evolution not revolution, and speak of pilot studies. And since the roll of doubters is long and impressive, it is worth looking at it and its concerns a little more closely. The names on the list include the British Medical Association, the Royal College of Nursing, the Royal College of Surgeons, the Chartered Society of Physiotherapy, the Society of Radiographers, the Liberal Democrat Party, the King’s Fund, the health unions, health charities such as Diabetes UK and the British Heart Foundation, and individuals like Baroness Williams of Crosby, Lord Winstone, and – more importantly – a fair number of GPs and their patients, especially the older ones.
Bones of Contention The bones of contention that concern this array of critics range from GPs who don’t want to be commissioners and would like to be able to decide on their patients’ needs without having to be concerned about the cost; and hospitals that don’t want to lose services to the community and have their budgets cut; to anti-centralists who fear that the powers of the proposed NHS Commissioning Board and the NHS economic regulator Monitor will be much too wide-ranging in a reform which is supposed to devolve power to local clinicians. Above all else though, the objection that is most common to the ranks of the doubters is that the reforms open the way to the privatisation of the NHS by stealth. A fear far from allayed by the recent remarks of the new chairman of Monitor, David Bennett, who favours more competition in the negotiations regarding medical services with the NHS contracting system operating on much the same lines as procurement in the defence industry.(4)
The “Future Forum” So what is likely to happen in practice? I believe that there will be some amendments to the Bill, with the scheme as originally presented being altered as a result. Indeed, the Bill’s progress 4 | WWW.PRIMARYCAREREPORTS.CO.UK
through Parliament is already paused to allow for fur ther discussions with patients’ representatives and NHS staff (especially nurses) via a Future Forum chaired by former Chairman of the Royal College of General Practitioners, Dr Steve Field. The Government sees the new Forum as a channel for the thoughts and opinions of patients and staff and Dr Field has already said that, since listening to the NHS people on the ground is vital, he sees the new group as a real chance for these people to have their say in helping to shape the future of the service. The Future Forum will focus on: - the role of choice and competition for improving quality - how to ensure public accountability and patient involvement in the new system - how new arrangements for education and training can support the modernisation process - how advice from across a range of health care professions can improve patient care. Speaking at the Forum’s launch, the Prime Minister assured the public that any good suggestions to change the current legislation which arise from the discussions will be accepted, but reiterated his view that modernisation of the NHS is essential if we want a truly world class service. The Health Secretary insisted that good progress towards modernisation had already been made such as the 6,500 GP practices and 90% of Local Authorities signing up to play their part in improving services for patients.
Likely Amendments to Proposals As for the results likely to be recommended by the Forum when it reports in the early summer, Dr Field has already commented on some obvious needs that it must address – such as stopping the ‘cherry-picking’ of NHS services by private companies, the protection of workforce training, and the addition of hospital doctors, nurses and other health professionals to the new GP Consortia. Obviously, despite such changes, the Government will proceed with its basic plan, because, in a time of financial freeze and widespread cuts, they need the savings that reduced hospital care and the abolition of the PCTs and SHAs will bring to have more money to spend on maintaining and improving frontline services. And there are reasons, I believe, for hope that they may be right. Giving GPs the purse-strings to buy secondary care certainly adds to their responsibilities, but it also has a ring of common-sense about it, as
SPECIAL REPORT: REFORMING THE NHS IN ENGLAND
do any arrangements whereby the Consortia and Local Authorities are linked closer together in partnership, not only for social care but because otherwise Public Health will be solely in the hands of Councils and the Department of Health.
Quality of Care and Vocation The reform is also very much in line with the World Health Organisation’s 30-year old Global Strategy for Health for All (5), whereby all countries, whether developed or underdeveloped, are called upon to remember that health resources are limited and that the total health needs of a population cannot be met by modern technological hospitals practicing scientific medicine alone. Primary Care must form the hub of any true national health system, using all the resources at its disposal – public and voluntary – to concentrate not just on curing ill health but equally on its prevention and the encouragement of self-help and healthy living. The Strategy also stressed that while any care is better than none, the quality of care which a service provides is as, and perhaps more important than, the quantity, with quality relying heavily on one factor as far as all types of healthcare staff are concerned – Vocation. Those involved in the present reforms would do well to remember this.
Private providers are prevented from creaming off the more profitable services and leaving the
Demonstrate develop NHSand to deal with your management skills by joining the IHM’s the more difficult,
Accredited Manager Programme more complex and more expensive services
Demonstrate and develop
your management skills by joining the IHM’s
Accredited Manager Programme
and the problems The programme is fast becoming a nationally recognised of staff training. symbol of excellence in healthcare management across the country
funded service as long as it does not breach the basic NHS principle of equal treatment for the programme and... The programme is fast all free at the pointJoin of provision. And, private Will Reforms be Successful? Enhance providers are CV prevented fromstrengthen creaming off the becomingteam a nationally your and/or your management So, is the restructuring going to be successful? more profitable services and leaving theto NHS to pursuit Demonstrate your commitment the of excellence recognised symbol of We can but wait and see. Meanwhile, an deal with the more difficult, more complex and excellence in healthcare encouraging pointer for the Government comes more expensive services and the problems of (6) from Cumbria where GPs have had control of staff training management across their own budgets since the latter days of the last And the Consortia join will know as well as every we February, June Individuals the programme October theorcountry Labour Government. There, PCTs are virtually do that the best insurance scheme truly Organisational cohorts canfor beabespoke to meet local need. abolished, the area’s nine community hospitals national health system designed to meet the Join the programme and For further information, have been saved, the average stay in the two total healthcare needs of the people,please is oneemail education@ihm.org.uk local main hospitals has been reduced from 36 based on bothaccredited they, and Thetaxation. programmeIn willaddition, be academically Enhance your CV and/or strengthen to 10 days, and standards of patient care have a large number of their patients are well aware your management team risen. But in Cumbria the local doctors joined that moving away from paying for care through Demonstrate your commitment the scheme by choice. They were not forced. their taxes will very likely, in the end, mean paying IHM poster.indd 1 16/5/11 10:16:19 to the persuit of excellence Something for the Health Secretary to note even more in health insurance, and will carry with perhaps. Evolution, not revolution. it the danger of ending up with an American-style system whereby those who can afford it have top Ensuring Free and class private health insurance and those who Individuals join the programme Fair Healthcare for All can’t – who are likely to be the poor, the longevery February, June or October. Meanwhile, there remains the question of term sick and elderly – are forced to rely on a Privatisation. Do the Government’s proposals minimal, third-rate public service to cover their Organisational cohorts can be take us a step towards privatising the NHS essential needs. bespoke to meet local need. or not? Personally, I don’t think so. The new And, bearing in mind the current outcry Consortia will be able to commission outside against poor standards of some care for the providers (charities as well as profit-making) for elderly and complaints against nurses to the For further information, please some clinical services if they believe that that is Nursing and Midwifery Council reaching record email education@ihm.org.uk clearly the most efficient use of funds and the levels (more than 3,000) last year, I can’t see most suitable for their patients. Just, I imagine, any British Government doing that, or the as PCTs can do today if they wish. This I would British people allowing them to do so, even if The programme will be academically accredited see as reasonable competition in a publicly they wanted to. WWW.PRIMARYCAREREPORTS.CO.UK | 5
SPECIAL REPORT: REFORMING THE NHS IN ENGLAND
References: 1
‘The NHS will sicken unless we modernise”. Article by David Cameron in The Times, Saturday, January 31st 2011.
2
“What do the Government’s Reforms mean for the NHS?” Article by Anna Dixon, Director of Policy, The King’s Fund, London, in the NAPC Review Spring 2011.
3
“Good management must be at the heart of NHS reforms” Article by Ruth Spellman, OBE, Chief Executive, Chartered Management Institute, in eGOV Monitor Blackberry, 02/02/2011
4
“A spoonful of competition is ordered to revitalise NHS” Chris Smyth, The Sunday Times, 25th February 2011.
5
“Hospitals and the healthcare revolution” by LHW Paine and F Siem Tjam, published by World Health Organisation, Geneva, Switzerland, 1988.
6
“Take it from Dr Shake-Up, this works,” Margarette Driscoll, The Sunday Times, January 23rd 2011.
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