NHS cuts and their impact on the UK's ageing populationPosted by Neil Churchill
Before the election, all of the parties argued for there to be no more ‘re-disorganisation’ of the NHS. Now, the coalition government has produced plans for the most radical shake-up of the health service since it was founded. It’s not great news for managers, but what does it mean for the patient?
To some extent your views will be influenced by your politics. Conservative politicians acknowledge that their reforms are designed to leave the government as the funder and regulator of health and not the owner of hospitals or the providers of healthcare. They want to take the politics out of the NHS and the state out of monopoly health provision. For the first time I can remember we have a Secretary of State using legislation to limit his powers over a public service. This is a huge contrast from New Labour, who grew the size of the NHS and used first targets and then entitlements to try and improve the quality of care patients receive.
If you are an expert patient, then there is much that you will like in the proposals. Patients can expect to be given much more influence and control. Already we can compare the success rates of different hospitals. Soon we will be able to compare the quality of different wards, the survival rates for different doctors and the patient satisfaction of different GP clinics. We will be able to choose any willing provider for our care – which may be private sector or NHS, it doesn’t matter so long as they are willing to do the operation for the tariff fee. Our views on satisfaction and quality will count a lot more in measuring success, so institutions which provide poor service will lose out even if their clinical care is good. And the government plans a new mechanism for funding new drugs, which could mean that patients get faster access to more of the latest medicines, without finding them blocked by NICE because the cost-benefit case does not meet an arbitrary price ceiling.
There is a strong chance too that new forms of care will open up, many of them coming from new forms of provider. For example, many people like me value convenience highly in our care. We don’t want to take time off work to see a GP when we could manage our own long-term condition on-line. Similarly, many people want to use the latest technology to self-manage, be that through their mobile phone or the latest developments in telemedicine. More of these initiatives should be available faster in the new look NHS, with its emphasis on competition among any willing provider.
However, if you live in part of the country where services are already poor then you may be less happy with the proposals. At Asthma UK, we know that you get a poorer service in some cities and regions than you do elsewhere. Your chances of ending up in hospital for an asthma attack that should have been prevented are eight times higher in some towns than others. The standard of care in some parts of the NHS has been described by NHS leaders themselves as being ‘woeful’. If you live somewhere like this, it is not all that likely that you will find a local practice much better than your own and you can’t choose and book a hospital if you are having an acute asthma attack. Under the current system, NHS organizations have a range of incentives and management pressures to do better. Under the new system, you could be dependent on health professionals deciding that quality needs to improve. In my experience, good doctors are reluctant to criticize poor doctors and slower to try and take over their business, so professional standards will not be a fast route to service improvement.
There is also the risk that the whole reform could unravel in face of funding pressures. The NHS is protected from cuts but it still needs to find £20 billion efficiency savings to pay for extra demand that comes from medical inflation, an ageing population and new medicines and technologies. Yet the managers charged with finding those £20 billion savings have now been told that their jobs will be going by 2013. Many of them are now thinking more about their own future than they are about productivity gains. This hurts the patient, because if the NHS does not find these savings, we will all pay the cost in longer queues for treatment and longer waiting times. Targets are certainly problematic and cause unintended consequences but waiting times are a crucial part of patient experience.
So is the glass half full or half empty? It may be too soon to say. The direction of travel is clear but much of the detail is still unknown and making a change like this will take time. More consultation document are on the way. Two of the most important – on patient choice and on the promised information revolution – are still awaited. There is a powerful vision behind the reforms but the risks are great too. Radically reforming a service with a million staff and an £80 billion budget, whilst making large cuts and eliminating tiers of management is a hard task to bring off but that is the task Andrew Lansley has set himself. One way or another it will end up in the textbooks.
Neil Churchill is Chief Executive of Asthma UK
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