April 1st saw the biggest reorganisation of the NHS since it was created in the 1940s. One of the largest changes has been who makes the decisions about healthcare and what services are provided.
Prior to 1 April there were a large number of Primary Care Trusts which controlled local spending. For the most part these were run by health managers. About 20% of NHS spending was controlled nationally to include issues such as the specialist care centres. Whilst there is always a great deal of criticism about managers in the NHS, the fact remains that they are reasonably skilled at resource allocation.
The Primary Care Trusts have now been replaced with what is known as the clinical commissioning groups. There are more than 200 of these and they are GP led. By contrast to the managers, GPs have very little experience of resource allocation. That is not their role.
In any event the Clinical Commissioning Groups will control approximately 60% of the NHS budget. Technically each GP surgery belongs to one but the reality is that only a small number of GPs wish to be actively involved. Your local GP therefore may be a member of the groups that makes decisions but have no control over it. So the decisions will be made by a smaller number of GPs and not necessarily reflect local needs.
Primary Care Trusts are therefore abolished and under the new system the Clinical Commissioning Group can commission services from the NHS Hospitals, private hospitals, community care organisations and charities. They are not obliged to use NHS services for all care and indeed it is anticipated that routine operations will be carried out by a number of private companies albeit that it will then be paid for by the NHS.
Private companies do not, of course, do this out of any sense of charity or philanthropy towards patients. They do it for profit. Profit for which the NHS is paying.
A new regulator has been designed to deal with this called Monitor. The role of Monitor is actually to ensure that there is equality of arms between the private companies, charities and NHS organisations. In other words that they can compete equally whilst this will not affect patient service. Quite why the NHS has to compete with private bodies and charities is not really known but is clearly a political decision.
Before 1 April the overall responsibility for Primary Care Trusts went to a strategic health authority. This has been abolished. We now have an NHS commissioning board and a large number of regional and local offices. In short, we have more and different administration, the cost of implementation of these plans must be significant. That is also a cost paid by the NHS.
It is not clear whether this new level of administration will be of any benefit to the NHS or to the patients within it. What it does mean is that private companies are allowed, indeed encouraged, to tender for work and to provide services which the NHS previously did.
The reality would appear to be that this is the first step towards wholesale privatisation of the NHS via the back door.
The NHS is reorganised to give doctors who do not have the skills to allocate resources, is monitored by an organisation which has as one of its aims ensuring equality between the private and NHS sector and has created a different but substantial level of management. Bear in mind that the private finance initiatives in the NHS have not proved to be quite the success envisaged. It is difficult to see how the introduction of more profit making enterprises will result in better patient care. Profit and care don’t automatically go together.
I spend a great deal of time dealing with the Claimants who have had private care and then needed the NHS to deal with the emergency that has resulted. I don’t see that the need for profit has assisted the situation, rather it has complicated it.
At the same time as the changes to the NHS were the dramatic changes to the legal system and clinical negligence litigation in particular. For many clients taking a legal case will prove to be more difficult or expensive or both. These misnamed “reforms” mean that Claimants who are innocent victims of negligence now will contribute to the costs of trying to put things right.
Both healthcare and access to justice are fundamental rights, not issues for sale or profit. It seems that the ordinary patient will end up paying for the changes. Sadly if something goes wrong, they may not be as able to seek redress as they did. Profit is apparently good for the private medical providers and the insurance companies. For the Claimant, they are not allowed to even break even. What about the equality for them?