U.K. HEALTH REFORM (2)

The Coalition Government's plans for shaking up the much-loved National Health Service were radical, though misguided in my view. Too radical for many. Following the inevitable backlash, the Government called in April for a 2-month "listening period", during which people could come with their criticisms. Nothing wrong with that, in principle; the problem was the timing. This sort of thing is usually done before legislation is submitted to Parliament, after the publication of a White or Green Paper. But the NHS Bill was already wending its way through Parliament, so stopping it must have caused some problems.

Given the Liberal Democrats' thumping at the local elections in May, and the rejection in the referendum of changing the first past the post electoral system, which they had campaigned for, their leader Nick Clegg badly needed something concrete to show that his concept of "muscular liberalism" was not merely an empty slogan. The listening period provided it. In teaming up with healthcare professionals anxious to protect their turf, they have put a huge spanner in the original works. Budgets will still be transfered to general practitioners and primary care trusts will go; but instead of the change being compulsory and by 2013, it will be voluntary and over a longer time period. Other changes are that hospital doctors and others will have a say in the GP consortia's purchasing decisions through clinical "senates"; and the health regulator's former duty to promote competition between healthcare providers has been watered down to a requirement to use competition to ensure choice and integration. 

The original blueprint, although wrong in my view, at least had the merits of simplicity; GP's would see to nearly all of a patient's healthcare needs, either providing it themselves or purchasing it from third party providers (both private and public, who would compete to supply it). The new proposals look a bit of a dog's breakfast. The layers of bureaucracy will stay the same (PCT's out, clinical senates in), GP's get more reponsibilities but not more power, and the private sector is still banging on the door, trying to get in. All in all, not a good reform.

Walter Blotscher