The fact that a Conservative government are drawing up plans to dismantle the National Health Service can come as no surprise to anyone who has listened to anything they have said for the last five years. Those who blindly voted Tory looking for nebulous “change” should note that the grass is not always greener on the other side of the polyclinic.
The fact that the NHS will be broken up whilst the Liberal Democrats are in government may come as more of a surprise to many. But a review of their manifesto provides plenty of warnings.
Before the election, back when they were concentrating on Bringing Back Fairness, they committed to scrapping Strategic Health Authorities. They also talked about elected Local Health Boards, which would supplant the Primary Care Trust as the main commissioning body. The only difference between that plan and the Lansley plan is the removal of the public. Ironic that the Lib Dems should implement their policy having carefully removed the democracy
The National Health Service will remain the largest health insurance scheme in the world but, after these changes are implemented, it will be in the hands of private companies, all of which will have a duty to their shareholders to take money out of the system.
Let’s look at this main change of “Physician-led Commissioning.” This means that, rather than the local Primary Care Trust making decisions as to where money should be spent, those decisions will be taken by a consortium of around 70 GPs. They will decide which specialist services are available in their local areas, and how different proportions of their money should be spent.
The rationale for this is that GPs who are seeing patients every day are better placed to make these decisions than the much maligned NHS managers who are bleeding our hospitals dry, etc.
Of course, rather than being the bogey men they are portrayed, most NHS managers do a good job of taking these administrative decisions away from GPs, who have much more important things to deal with. Like you. Asking a GP to deal with this level of bureaucracy would be like pulling Steven Gerrard off at half time so that he can help renegotiate the Liverpool FC overdraft. His job is to score goals.
The GP’s job is to look after patients.
Of course, GPs are no fools. They know they are not qualified to make strategic decisions – they have a ground-level perspective which is beyond comparison. But a great platoon commander does not always make a good General. Most GPs got into the job to treat patients, not to stand behind a desk directing resources across the NHS battlefield.
For this reason, these GP consortia will outsource the management of this responsibility to private companies. These firms of consultants will spring up over the next few years in response to the changes. Some will be owned and operated under American management as this system is more commonplace in the United States. Like any private company, their first obligation will be to their shareholders, and so any profit made will be taken straight out of the NHS and away from patients.
These companies will be staffed by the only people who have any experience in strategic healthcare provision – the staff of the defunct Primary Care Trusts who have just been made redundant.
So GPs will pay a private company to come in. That private company will pay its staff considerably less than they were earning within the NHS, charge the GPs a fraction less than the previous cost of the PCT, and keep the profit for themselves. This will be trumpeted as a victory for the public purse. When the reality is that we just funnelled money directly into the private sector at the expense of workers.
And with private money comes private competition. What will happen when GPs, having studied for over a decade to be an expert clinician, prove themselves unsurprisingly hopeless at running a business? As with failing schools, the best private firms will be brought in to “rescue” the surgery.
Costs are cut, staff are laid off, the level of service to the customer / patient falls away but the books are balanced. The private firm takes its profit and the surgery gets a big blue tick next to its name in the government’s ledger. Another successful surgery.
Unless you’re trying to phone them. You see, they’ve saved money by using one of those interactive voice menus and laying off a member of staff. Great profit centre, but you can’t actually speak to a human being.
Welcome to the brave new world of healthcare provision. To put your head in your hands and weep, please press 1.
This post was first published at The Confidence Interval