Liberating the NHS?

Equity and Excellence: Liberating the NHS, the government’s white paper on health service reforms has been published. Download it here.

I never thought I would see a government presided over by a Conservative prime minister say:

It is our privilege to be custodians of the NHS, its values and principles. We believe that the NHS is an integral part of a Big Society, reflecting the social solidarity of shared access to collective healthcare, and a shared responsibility to use resources effectively to deliver better health…. We are committed to an NHS that is available to all, free at the point of use, and based on need, not the ability to pay.

It rings every alarm bell I possess.

The Social Enterprise Coalition has broadly welcomed the white paper, largely on its commitment to ‘create the largest social enterprise sector in the world’. Peter Holbrook, SEC’s chief exec notes, however, that much more detail is required regarding how (I would have said ‘whether’) GP commissioning will work, and further clarity regarding the role of foundation trusts, which the white paper appears to regard as already synonymous with social enterprises.

It is claimed that the reforms will slash 45% from NHS management costs and liberate a billion pounds that can be reallocated to front-line services. 10 strategic health authorities will be abolished by 2012 and the 150 primary care trusts scrapped by 2013; up to 30,000 managers face being cut or redeployed. Writing in the Guardian yesterday Randeep Ramesh called this a ‘radical pro-market agenda‘ for the NHS which, according to one analyst, could herald the ‘denationalisation of healthcare services in England’.

Passing commissioning budgets and responsibility to GP consortia — which the majority of GPs are against, according to HealthCareRepublic — will also create massive opportunities for outsourcing companies (People Management). Yesterday’s Guardian editorial pointed out that buried in the white paper’s small print is a proposal to turn Monitor, the body that currently oversees the foundation trusts, into a ‘full-blown economic regulator to oversee a healthcare market’, rather like Ofcom and Ofgem oversee the markets in communications and energy.

The Patients Association has said ‘these changes are a huge experiment without much hard evidence about how they will work’.

To the non-health specialist these are also fantastically complicated issues, making it extremely difficult to know what positions the sector should adopt on this.

I know we have some health specialists amongst the readers of this blog, so please comment and share your thoughts. We should be pooling intelligence on this!

  1. Simon Lee Reply

    I am for social enterprise (otherwise I wouldn’t be part of BSSEC!), and also for social enterprise as part of NHS service delivery (otherwise I wouldn’t want to be working on things like the ‘Right to Request’), but to me this is several steps too far.

    I would like to see an NHS where social enterprises have a fair chance of competing for work that comes along: I think the sector has a lot to offer here.

    I’m not one for ‘non-jobs’, excessive bureaucracy, etc, etc, but I really can’t see how such a de-centralised system of commissioning for services would really work. How would potential contractors ‘meet the commissioners’, for example, if they have to try to get to know multiple sets of GPs rather than one PCT.

    I’m also not convinced that GPs themselves would want to take on this extra responsiblity (at least not without asking for more money). Surely, then, it would be passed on to individuals or organisations to do it for them, in which case, what’s the advantage over the current system?

    I suspect that this will be adopted anyway, whether we like it or not, so I guess we have to be pragmatic in the sector: to adapt quickly to changing circumstances, and to look for the opportunitites that will inevitably arise (for both social enterprise and private sector alike).

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