Monday, 19 August 2013

NHS Reforms: Inspiring Sustainable Governance?

As I launch myself into the depths of the NHS I am unveiling its mysteries to myself, and I thought I would share it with you. The Health Care and Social Act 2012 came into effect in April. Except for the large amount of press on failing care in a few NHS hospitals, the effects of the structural change it self have not been obvious to us as service users.

What has changed? Primary care trusts, led by health managers are being phased out. GP led clinical commissioning groups are now in charge of the NHS budget (£108.9 billion 2012/13) – each GP surgery is linked to a specific group. The idea is that GPs have a greater idea of the needs of patients, in a way it is empowering at a local level. It is a good sustainable idea in principal, but…
-   Only a small number of GPs will actually choose to get involved, and therefore their decisions may not actually reflect local needs.
-   Do GPs have the correct skills to administer the NHS? Are they not better used for patient care as they were trained?
-   Empowering GPs at this level runs the risk of money and costing becoming a priority over patient care – profit based decision-making.

This last point is my main worry. Clinical Commissioning groups under the new act are free to choose to outsource and spend NHS resources on privately sourced services, for example sending patients to private hospitals to receive routine operations. Is this a secretive slippery slope to the privatization of the NHS? This competition-based system will create increased conflicts of interest at all levels. GPs may even have shares or own the clinics for which they refer their patients to. Will (or for the pessimist, when) they begin to make decisions based on their own business interests and financial gain rather than their patients needs? Will financial competition come out on top over patient interests? Monitor, a newly set up regulator is supposed to oversea these public/private transactions. This is one huge task, especially in what seems an increasingly complicated system. I just hope it doesn’t create confusion and conflict within and between all these governing bodies.

So I have only just scratched the surface of the NHS reforms; do they seem to be paving the way to a sustainable governing system to you? I will delve into some particular parts of the NHS in further posts.

Here are some good links if you want to read up a bit more about it:
http://www.theguardian.com/society/interactive/2012/mar/15/nhs-reforms-100-voices-interactive
A great video from Channel 4 on the conflict of interests: http://bcove.me/xf1xp322

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