Sleepwalking into the market
BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f1850 (Published 20 March 2013) Cite this as: BMJ 2013;346:f1850
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Dr Godlee appears to be unaware of the real, immediate problem facing Secondary Care; the lack of clarity about which commissioner (i.e. the actual person or office) with whom to negotiate specific contracts.
Some aspects of the service (for example, psychosis) have potential subcontracts with national, regional and local bodies, with major problems dividing the financial responsibilities.
My own area of interest - Dementia Care - ideally needs a combined secondary care package - between Geriatrics, Old Age psychiatry and Radiology - to be effective. I cannot see this is easy to organise despite ongoing good relationships locally between the departments (not necessarily reflected in managerial relationships).
The department of health is very likely aware of this issue, which might well end up in private health brokerage firms (like virgin health care) being handed over functions of achiving contact, and to 'knock heads together'. These firms will receive 'appropriate' reinbursement for their efforts, with the NHS footing the bill.
Perhaps what the ministers were hoping for anyway!
Competing interests: No competing interests
If only we were just sleepwalking and Dr Godlee could wakes us from our slumber before it is too late.
Unfortunately the passage of the bill and it's progress and has been actively supported by our colleagues who have embraced the opportunity for clinician involvement in commissioning whilst ignoring the bigger picture of the market based ideology that is the foundation for the bill.
If those of us who have voiced our fears for the future of the NHS prove to be correct the responsibility for the dismantling of the service will lie with both the policymakers and the clinicians who allowed their ideology to be enacted.
Competing interests: No competing interests
This is not sleepwalking; this is a conscious and deliberate policy change that has been steadily promoted by all three political parties.
It would have been very simple to draft regulations that unequivocally delivered ministers repeated promises that privatization was not being forced on the NHS.
There is only one credible explanation of why this has still not happened; privatization is precisely what is intended, but this needs to be concealed for as long as possible.
Dr Graham Winyard
Past NHS Medical Director and former Liberal Democrat
Competing interests: No competing interests
The Academy of Medical Royal Colleges wrote to Earl Howe, the Health Minister for England, over concerns about the original Regulations which were subsequently withdrawn. We have been considering the revised Regulations and the comments from the House of Lords Secondary Legislation Committee (33rd Report). Differing views have been expressed as to the implications of the Regulations. As is proper for a membership organisation we are therefore now consulting our members to seek their views on the revised Regulations and the appropriate way forward.
Professor Terence Stephenson, Chair of the UK Academy of Medical Royal Colleges.
Competing interests: No competing interests
I think it is a bit late to start looking at the consequences of the Health & Social Care Act 2012 9 days before it comes into force on 1.4.13!
As a grassroots GP I have been aware of the damage planned - and the sub-plot of opening up the NHS to private suppliers and enforced competition since Andrew Lansley started the process - a few weeks after the Coalition Agreement stated that "there will be no top-down reorganisation of the NHS": after this extremely rapid reversal of manifesto and Coalition pledges, by a government without a mandate, could anyone seriously believe the statement that "GPs would be in charge" and "the NHS will not be privatised"?
S.75 was always going to be a risk: any changes dependent on secondary legislation - seldom noticed until too late and difficult to get debated - are suspect: as this was so important, omitting it in primary legislation ought to have caused - and did cause - alarm at the time.
Once the Bill had been forced through on a 3-line whip (IIRC) and passed by the Lords (did they ever sort out the seating after Cameron's new 105 Lords?) I decided that this was a re-structuring too far for me to manage: I am retiring from General Practice on 31.3.13 - and I doubt whether I am the only GP taking this course.
Competing interests: No competing interests
Re: Sleepwalking into the market
Godlee and Reynolds are right to point out that the current changes to the NHS are the culmination of a process which began with the introduction of the "internal market". The belief that the NHS is best run as if it were a business has been endorsed by all subsequent governments, despite the lack of any convincing evidence to support it.
From this perspective, it is a logical step to move from a quasi-commercial system to a genuinely commercial one. The Government's intention is symbolised by the decision to rename the NHS Commissioning Board "NHS England", with the clear implication that the primary role of the NHS in England is no longer to treat patients but to buy services from the cheapest supplier.
These changes do not just threaten the fundamental basis of the NHS as a free public service, important though that is. The NHS, almost uniquely in the world, has the potential to provide integrated, planned healthcare for an entire population and to do so in a highly cost-effective way because it is not required to generate a profit or pay a dividend. Losing this will be a very high price to pay for irreversible, ideologicallly driven changes which are ultimately based on nothing more substantial than a naive analogy between delivering healthcare and running a supermarket.
Competing interests: No competing interests