The Guardian has reported in the last hour or so:
Andrew Lansley, the health secretary, announced today that the government will push ahead with radical plans to shake up the NHS — the biggest shift in power and accountability in its 62-year history — despite opposition from almost every part of the health service.
Among those raising the alarm in the 6,000 responses to the white paper — about the size and scale of the planned reforms — were the Royal College of GPs, trade unions, and the respected health thinktank the King's Fund.
The British Medical Association described the timetable for the reforms as "foolish" and warned that patient care could suffer as a result. Lansley said critics' claims were unfounded.
Let’s not beat about the bush: this is in breach of all election promises not to “top down” reform the NHS, it’s most extraordinarily unwise and it will kill you, the NHS or both unless it kills the ConDems first.
The NHS is much beloved for good reason. It works. I know. I’ve spent much of this morning in a hospital with my son for yet another in his litany of broken bones (how one manages it, seemingly often and the other never baffles me). As ever, I remain in awe of the fact that as nation we supply such an amazing service at lower cost than most nations on earth free to all comers. It’s a staggering achievement spoiled only by the fact that if organisation as centralised, the market was removed from the equation and the NHS concentrated on supplying health care without all the bureaucracy that PCTs, Foundations and so on all impose when a few regional strategic health authorities could do the job so much better.
Instead that beauracracy is to get so much worse:
At the heart of the change is the shift of £80bn of taxpayers' money into the hands of England's 35,000 family doctors who operate as essentially private businesses. Lansley admitted that he had conducted no surveys of GPs before launching the white paper — despite outright opposition from one in four GPs.
I must declare an interest: I am married to one of that35,000 but the views here are mine, not hers.
GPs are (by and large) considered just about the most successful professionals in the UK with the highest approval rating of any profession and, by and large that’s for very good reason. Most work very long days at considerable intensity often making the sort of decisions most of the rest of us would really rather avoid (life and death stuff) or facing harrowing situations that again most of us would run a mile from. Sure tey deal with sniffles too — but that’s a minor part of the job that makes the rest possible by giving time for a rare cup of tea.
But to say they run small businesses is ludicrous. They get 97% plus of their income for being there. They employ staff on pretty much NHS terms. Their premises are provided, as is their IT. They work to protocols set by others. A few do some minor ops and think they’re really entrepreneurial. No doubt they’re the ones advising Lansley. They’re deluded. From what I’ve seen of GPs the average one hasn’t the business ability to run an ice cream van in August. More important, they have no spare time at al and they’re not going to be given any to run the NHS.
So the claim that they’re going to do so and maintain front line services is a lie. And a blatant one. We’ll have fewer GPs or an NHS run by contractors, and probably both.
And the culture they’re already being told to follow is one of competition — compete on price to knock down hospital prices. Compete with hospitals on providing services. And more of the same.
This completely ignores the fact that the NHS only works as a whole. GPs can’t work without hospital backup. Hospitals would fail without GPs seeing more than 90% of all NHS contacts so stopping A&E being inundated. This is an integrated service that Lansley wants to destroy — and destroy it he will.
I support the students and sixth formers in their fights with this government.
I hate the unemployment this government will suffer as a result of the callousness of George Osborne. but the collapse of the NHS will bring this government down. And it will collapse because a great many GPs are old enough to retire if put under pressure, and retire they will — and already young doctors are not training as GPs because it looks such an undesirable option again. This is going to be the frontline. And rightly so.
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I worked as a GP in the NHS for 31 years until I retired, all in the same practice. We lived with constant change and innovation, adapting to whatever bright idea the politicians dreamed up next. Most change was non-evidence based, there was never any piloting of fundamental change and no-one ever asked the people who had to implement change. We were like mushrooms, in the dark and with shit periodically flung over us. Still, our practice prospered due to professional commitment and our ethos was to deliver the highest quality care within resources. We achieved, and still do, over 98% immunisation rates for kids, the practice met all the targets thrown our way every year with the last lots bright ideas. However I despair. The latest government have had 13 years to prepare a strategy, they could have let the electorate know what they intended and now they are planning a huge shake-up which is privatisation by the front door, rather than Labour’s back-door approach. GPs are very busy and we are trained as doctors, although small business management skills are essential, so who does the work? Probably the management will be farmed out to those private health care companies champing at the bit on the wings, for whom so many political donations and lobbying will now come to fruition. Andrew Lansley will go down in my book as one of the most disastrous Health Secretaries of recent years – and they have hardly been a stellar bunch.
I am a little surprised that as the husband of a GP you state that ‘the average one doesn’t have the business ability to run an ice cream van in August’. I thought that my views were quite strident on this subject
(see a previous comment from me). I understand that some management staff from PCTs and SHAs will probably get rather large pay offs and then be reemployed by the new commissioning consortia so that will save the taxpayer lots of money!! These reforms have no political mandate but are excellent examples of Naomi Klein’s Shock Doctrine therapies which I never thought would come to pass in a democracy. They have of course been used in autocratic Latin American countries following advice from the ‘Chicago Boys’ and mainly with disastrous consequences. I anticipate social unrest on a large scale in the UK followed by a crackdown by the ‘Surveillance State’.
@Teresa Harding
I said the opinions were mine alone
But I suspect my wife would agree on GP business acumen
Remember, none have business or accounting training – and I’m afraid it shows
But apparently that’s OK – they can have £2.4 million each to spend – which is ludicrous