NHS reforms must go ahead, but are only the start of a difficult journey.

Guest blog by Andrew Burns

Board Member and Treasurer 2020health

General and Colorectal Surgeon

 

The NHS has featured strongly in the headlines this week. Nurses at the RCN Congress complained of “crisis management” on many hospital wards, passed a vote of no confidence in the Health Secretary, Andrew Lansley and are considering industrial action over proposed pay freezes. John Heyworth, President of the College of Emergency Medicine told the Guardian, “The emergency care system is struggling to cope at the moment….because of the number of patients coming in, the limited number of emergency department staff and limited availability of beds.” The Audit Commission published the briefing for PCT commissioners on ‘Reducing spending on low clinical value treatments’. Finally some PCTs have requested GPs to only prescribe a months supply of medication at a time, to save money on wasted items.

Events this week testify to the NHS struggling to keep its head above water. Already a lack of money in overspent Trusts, and cash-strapped PCTs has lead to a number of Trusts cutting theatre sessions, closing wards, down-banding or laying-off staff. This is even before cuts are made to achieve the required £20 billion of ‘efficiency’ savings by 2014.

On top of this, is the growing demand on its services due to changes in population demographics, disease prevalence and rising costs of treatment.

If nothing is done to reform the NHS, matters will only get worse. It cannot simply be allowed to ‘evolve’ without a structured plan, as some have proposed. Although public satisfaction with the NHS is currently high, it will not last.

I’m sure the Government is only too aware of the slowly ticking time bomb of a major crisis in the NHS.

Of course, the underlying reason is money; there simply isn’t enough of it. Yes, improvements in organisation and efficiency are also crucial, but even with these, funding solely through general taxation will never be sufficient to meet the projected demands and maintain high standards of care.

Alternative healthcare providers will certainly help to shoulder the financial burden.

I therefore welcome the proposed GP Consortia being able to commission services from ‘any willing provider’ provided there is transparency, accountability and standards are maintained with auditing of outcomes. Competition between providers will drive efficiency, increase patient choice and slow the rate at which costs rise, but unlikely to lead to a lowering of costs.

Concerns have been raised that the proposals will lead to private institutions creaming-off the more profitable parts of the NHS, fragmentation of services and even hospital closures. Yes, these are real dangers, but service fragmentation and closures as part of local reconfigurations are already happening, and will continue to happen unless the foundations for structured reform are laid down.

Last week, the Prime Minister, David Cameron announced an eight week public consultation exercise on the controversial Health and Social Care Bill in which the Government would “pause, listen, reflect, improve” in response to concerns from bodies such as the BMA, Liberal Democrats and the Commons Health Select Committee.

Following this additional period of consultation, it is unclear as to the extent to which the original white paper proposals will be amended. However, whatever the final proposals are, it will only be the start of the journey. Despite changes in who commissions and who provides, there will still only be a limited (and insufficient) pot of money available from general taxation. Additional measures will almost certainly be necessary to limit costs. Patients will have to start taking some responsibility for their health and long-term care. The Dilnot Commission, examining the funding of long-term care and support, which is proposed to be a partnership between the state, individual and families, is due to report in July. It is probable that it will introduce the concept of patients having to take a degree of responsibility for funding arrangements for their post-retirement care, whether this is a lump sum paid at retirement or contribution towards a fund while working. In time, it is likely that a future government will extend this ‘partnership’ concept towards healthcare such as requiring patients to make top-up payments to their treatment, paying for low clinical value treatments and eventually having some form of insurance (a ‘dirty’ word at present) scheme, but with premiums weighted to encourage healthier living such as participation in weight reduction programmes if obese, smoking cessation, regular attendance at diabetic clinics if diabetic, etc, but this is a story for another time!