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Choice will benefit the NHS
Nick Bosanquet argues that Royal Free
job losses are down to the government’s failure to implement
NHS reforms
I LOOK back with pride on my eight years of service as a
Labour councillor on Camden Council (1974-82) when I had the
privilege of representing the good citizens of first Camden
and then Caversham, Wards.
It was a tough time – the party was over and we had to
find ways of getting more value for money. We did it through
shifting support to voluntary groups and independent providers.
We also fought to give better service and more choice to the
victims of state monopoly in council housing.
Now the party is over for New Labour and the NHS. The government
has come to see that vast funding increases have led to small
improvements in service.
We are still a long way from what is achieved in most developed
countries – immediate access to all funded services: and
the health gains of the last eight years in cancer and heart
disease, although welcome, have been assessed by independent
auditors as no better than in the 1990s.
There are many dedicated and caring professionals in the NHS
who try extremely hard to make the system work as well as it
does: but it is a huge, creaking bureaucratic system which has
great problems in delivering value for money or adapting to
change. The government is right to see competition and choice
as the crucial next moves.
The choice programme for people waiting for heart surgery has
led to big falls in waiting times.
The use of independent cataract centres has doubled the services.
Closer to home the use of external providers has steadily improved
care services for elderly people in Islington compared to the
halting progress in a Camden which used to be a leader in quality
of service or elderly people.
The usual argument against treatment centres is that they will
cherry pick, leaving the hospitals with emergency work.
This is an argument not for staying with the current system
but for using innovation to develop reliable alternatives to
hospital admission.
Some nursing homes are already providing intermediate care and
we need more providers in rehabilitation.
Reform urges more use of direct payments so that patients, carers
and GPs could choose in areas where the NHS has clearly failed
to provide as in hearing aids and stroke rehabilitation.
The Royal Free staff are the victims of the government’s
lack of will to face up to the problem. In 2004 our first report
on health funding showed the huge commitments that had been
made in pay contracts, PFI schemes which went far beyond the
funding available.
There is now a new problem of under funding. Staff that were
recruited last year are now being laid off. Could there not
be a clearer indictment, not of reform but of the old NHS system?
The transition to a new and more flexible system will be a difficult
one. GPs will be leading the way and indeed they have shown
how they can develop new services under the new contract.
At some stage NHS spending is going to come out of the period
of super growth and we are going to have to face up to the problem
of how to get more value for the health pound.
This must mean greater competition and new ways of making use
of the limited amount of experienced staff time. Patient choice,
foundation trusts, payment by results, and the new GP contract
all aim to give power to patients, carers and local communities.
The old NHS was an economic flat earth programme – we have
to find new ways of getting better services for patients and
using professional time more effectively.
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