U Turn on NHS Reform? I don’t think so. Do ‘U’?

Asks Andy Crow


The Government’s much trumpeted ‘U’ turn on NHS reform, with its accompanying ‘listening exercise and rethink’ has been one of the most effective PR coups in many years. The media storm of disapproval melted away and we were told to relax, because the government was taking our concerns into consideration and dealing with them. Harrumph! The Health and Social Care bill which was passed in the Commons last week (its third and final reading) is effectively unchanged and opens the doors to private sector businesses to compete for contracts against current NHS providers. The health service regulator, Monitor, will cease to be the guardian of patient and taxpayer interests and become a publicly funded, semi autonomous pimp for the private sector health companies that are itching to provide our health services with our money where there is a profit to be taken. This move may produce some advantages. It will certainly produce profits for big commercial companies. It is less clear whether it will afford any benefit to service users, patients and the taxpaying public. In the run-up to the election David Cameron promised there would be no ‘top-down reorganisation’ of the NHS. He avoids my accusation of being a liar only because what we are actually being presented with is a ‘reform’ that shakes the very foundations of the NHS. Nobody, not even the most ardent free-booting, free-marketeer, voted for this radical overhaul of the NHS because it was not on the agenda. It was specifically excluded from the agenda for this parliamentary session.

This is a free country. We are allowed to be in favour of privatisation of public services. We may well believe that only the market pressure of competition and profit will create the incentive that leads to good management and efficient services and, albeit perhaps reluctantly, we are prepared to see the ethos of public service as quaintly old fashioned and unaffordable. The best of USA medical services are probably better than our NHS, but they are more expensive, and leave millions of American citizens reliant on charitable provision and a third rate state safety net. I fear we are being presented with ‘reforms’ of our NHS which will gradually, but inevitably lead us into a similar predicament. No. Actually worse. Worse because the government’s lip service commitment to the ideal of universal provision will mean that a two tier, postcode lottery system develops ensuring that the best services, available only to the wealthiest, will be subsidised by taxation. I might be wrong, but…..

What does it mean for Cumbria? Alan Alexander, Chairman of the health service watchdog, Cumbria LINk, reports that he heard the Prime Minister say, twice, at a recent meeting in Carlisle that the £90 million for the refurbishing/rebuilding of the West Cumberland Hospital will be made available. That, as he says, should be good news. Quite what will be built and what services will be available is still not clear. (Neither is a completion date.)

The hospital management is currently up for grabs along with the Cumberland Infirmary as the current management is not able to meet the requirements to achieve ‘Foundation’ status to satisfy the government’s breakneck timetable. (No danger at this stage of a private sector takeover because our hospitals show little prospect of yielding profit. The ‘Tesco Hospital’ is a nightmare for the more distant future and will probably never happen) A merger of some sort with an NHS Trust from an adjoining Northeast or Northwest Trust or combined Newcastle/Cumbria Partnership joint management will be hammered out in the coming months. This will result in major changes. As with all changes there is scope for both advantages and damage.

For our own Cumbria Partnership this presents a significant challenge which is not entirely welcome. Having just this year taken over the running of community services from the Primary Care Trust a further expansion of responsibility is not timely, but may be preferable to seeing control and accountability devolved outside the county.

I’m not suggesting there is reason to panic and that the NHS is doomed. I am saying, ‘Be afraid. Be very afraid.’ Join the debate NOW, because in six months it will be too late. The ground will have shifted. and your opinion will count for nothing.

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