COMMENT
regulator Anna Walker (now responsible for rail regulation) urged government not to be a ‘slave to competition’ and to learn the lessons from other sectors about the scope of private sector involvement.
Postcode lottery?
A third question is whether the greater local variation resulting from the Bill will be a postcode lottery or a postcode democracy. In the new NHS, decisions about access to drugs and nature of local services will be made by GP consortia, rather than NICE or PCTs. This is likely to result in growing variation in what is available to patients locally. To what extent is this a good thing or a bad thing for patients? Will patients tolerate variability in drug provision? Are there aspects of care where strong national strategies or initiatives are needed? To what extent is there a need for a regional tier to determine strategy and implementation? Is the balance between the centre, the regions and the locality right? Are we losing the ‘National’ in our National Health Service?
Fourth, what about health inequalities and public health? The challenges facing the NHS are to a signifi cant extent the challenges of health inequality. Rates of smoking and obesity create rising pressures on NHS services. Emergency hospital admissions are higher in areas of disadvantage. And yet, these are often the areas where primary care is currently less robust.
The emphasis on information and choice, often delivered online, could exclude patients who need care most. How strongly will the needs of small numbers of patients with complex needs feature in commissioning priorities? Will the transfer of parts of public health services to local government deliver better population
Fifth, major questions have been asked about accountability and scrutiny in the new NHS landscape. Huge changes are being introduced into assurance, accountability and scrutiny mechanisms within the NHS. New Health and Wellbeing Boards will be established in local government to oversee health and social care.
What opportunities and limitations do they present? How should GP consortia involve patients and public in their decision making? Will there be greater transparency or will more decisions be taken behind closed doors? How accountable will the NHS be to Parliament and ministers and is the Secretary of State’s role clear and consistent? Are these tough powers or are the strings of accountability too weak?
“What does ‘good competition’ look like and how should it be introduced and regulated?”
Finally, one of the biggest questions for GPs has been whether patients will maintain such high levels of trust in the profession once GPs are responsible for rationing, especially if they could be perceived to be benefi ting fi nancially from it. Will the reforms change the public’s relationship with their doctors? Will shared decision- making help reduce use of expensive but ineffective hospital treatments? Will making GPs more responsible for their referrals and prescribing budgets help
health? To what extent will the new NHS be able to address health inequalities and improve the outcomes experienced by the most disadvantaged?
Scrutiny
Shadow Health Secretary John Healey discussing the reforms at a Smith Institute event. Photo: Nicola Langley- Essen
the NHS achieve huge effi ciency savings set out in David Nicholson’s £20 billion challenge? Indeed, will GPs be more effective advocates for change than PCT managers?
More questions than answers
The questions we are asking are not only about principle but also about detail. Many feel that the principles of reform are admirable, but the detail has not yet been thought through or not been clearly communicated.
Take the example of charging; the British Medical Journal reported that GP consortia and foundation trusts will have new powers to charge. That has been denied by the Bill team. But Barbara Hakin, responsible for commissioning development at the Department of Health, admitted in a recent interview that it could happen, but that if it did the NHS Commissioning Board would intervene.
As no-one knows how the Board will work yet, this is not reassuring to those of us concerned at the prospect of more charges.
Our aim in the inquiry will be to focus on facts and make concrete suggestions. I hope you will join us at one of our events, share your views and ask you own questions.
The next events will take place in Manchester on Thursday 16th June 2011 with Shadow Health Secretary John Healey MP and charity director of Age UK, Michelle Mitchell; and in London from 10.15am-11.30am on Tuesday 14th June 2011. Email nikki@
smith-institute.org.uk secure a place.
1 to Neil Churchill FOR MORE INFORMATION Visit
www.smith-institute.org.uk national health executive May/Jun 11 | 23
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