More Makeover Than Redesign?
All the pressure on the government over the flawed health bill has finally forced them to announce substantial changes. Only the detail will reveal the full impact, but from the headlines we can see that competition survives despite several other major concessions. In terms of policy direction, the rewrite seems more makeover than redesign. The NHS market is still being fired-up, but less aggressively and with more regulation and public scrutiny.
GPs still lead commissioning but will be joined by senior doctors, nurses and members of the public. Consortia will be more accountable and apparently less open to conflict of interest, yet the extent to which they will be guided by, or can link up with businesses is still unclear.
Mr Lansley told a commissioners’ event today that patient choice is his number one priority and he has confirmed that “without competition there is no patient choice”. The two are firmly joined in policy, but in political terms competition is tarnished and talked of far less boldy. But commercial providers understand the code – more choice means more competition and plenty of business opportunities.
In fact Mr Lansley has also confirmed that the controversial “any qualified provider” policy will go ahead, but only in areas where there is a fixed price. So concerns about bargain basement healthcare have been partially dealt with? Perhaps not if you consider that many parts of the commissioned NHS services are still non tariff.
What about privatisation? there will be none asserted Mr Cameron at the launch, at least not “a deliberate policy” to favour the private sector, as the government will outlaw this. Reassuring? Only if you ignore that fact that all the conditions for the transfer of services from the NHS to private sector are still in place. There is is no limit placed on this process and the vagueness of policy suggests posturing rather than a serious intent to block the private sector
Integration has popped out of the pause as the new buzz word to describe how services should link together for each patient. It certainly seems like a good change in emphasis, but unlike the future forum who are tripping over themselves to be pro competition, it less clear how you get businesses to consistently work together for patients is not entirely clear. Did anyone mention the shocking problems with Southern Cross at the launch? There is still a big fat assumption that it doesn’t matter who the provider is.
Although much progress has been made in the campaign it has only dented the government’s belief in a market based solution to healthcare. The proposals could leave us with a fragmented service lacking in strategic planning.
While it’s hard to object to Lansley's key theme of more patient choice it seems like the wrong priority. With the health service struggling to make cuts, waiting lists are on the up again and staffing posts are being lost. As he sweeps up his political credibility it would be good a time for Mr Lansley to begin to question his belief in market solutions for the NHS.
