Guest Blog by Gail Beer, Consultant Director, 2020health.org
The proposed reforms to the NHS are now taking a break while the Government decides how to respond to the numerous criticisms and increasingly vocal and angry NHS bodies.
Undoubtedly there are issues that need to be resolved and given more consideration. Amongst them the governance arrangements, which are just too loose, and it appears cannot be left to local managers to resolve. Further consideration too needs to be given to the role of public health and ‘health and well being boards’.
While the above do require attention and we here at 2020 fully support some changes, there worryingly appears to be opposition to any change what so ever. It would seem that the voices of those who wish to see things stay the same are winning the attention on every level.
We are told that restructuring is wrong! Cuts are bad for patient care; the introduction of GP consortia is causing rationing now and is likely to cause even more problems in the future; the use of the private sector would be bad for the NHS and bad for patients; localism must take place against a backdrop of central direction. At least one group doesn’t like something within the bill and these voices now hold sway, so the whole bill may well be altered.
Restructuring is always unpopular and does not always bring about the change required, however there is really no justification for the increase in managers over the last 10 years and we should question where the quantitative evidence is for the benefits they have brought. If clinicians really are better at determining how healthcare should be provided it cannot be an activity which they undertake without being accountable. Given the amount of money pumped into the NHS over the last 13 years why do we still see failures to deliver high quality care?
Change is essential if the NHS is to survive. The shape of our services must change, and this includes primary, secondary, tertiary as well as social care. Given that doing things as we do them now is not giving us the pace and depth of change we need and as yet does not demonstrate value for money it would appear that more of the same is the order of the day. What other solutions are on offer that enable us to meet all the challenges the future holds in a timely manner and demonstrate value for money?
Yet more of the same will not suffice in the end. We need undoubtedly do need to have a wider debate not just on these reforms but the future of healthcare generally, everyone including professionals and the public needs to understand that without fundamental change now the NHS may require an even bigger change later on and in a way that none of us can even contemplate or indeed may like. Will the public thank us then for not grasping the nettle now?