It seems councils are to be given responsibility to bring health and social care together and consortia of GPs will be commissioning health services under the new white paper proposals.
Will PCTs be missed? Are GPs the best people to commission services, including things like mental health?
What do you think of the plans?
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Honestly, I tried to read some of the details this morning but am suffering from 'reconfiguration fatigue' and really can't mentally buy into any more changes as we see so many so frequently until I see something actually changing or legislation drafted rather than white papers..
I know what you mean - why can't governments ever leave things alone for a while?
There is a very clear muddle in the proposed commissioning structures. Perhaps this is not so surprising given the politics that are driving the proposals.
While the ConLib’s make a great play that this is not about privatising the NHS, the financial structures and financial incentives they are putting in place are remarkably similar to the ones the Conservatives had in place for the utility privatisations.
On the one hand they say GP commissioners will hold and dispense the health budget but are taking out the risks to them by the department of Health by retaining the power to financially bail out failing consortia.
The inherent contradiction of supposed freedom of local commissioning and central financial guarantees is identical to the share price of utilities being under written by the government at the privatisation stage.
The telling part in the Whit Paper is the responsibility they give Monitor to “refer potential structural problems to the Competition Commission” They are envisaging a market of competing health care providers but are saying that the rules will be set from the centre so that if consortia were to decide that for their local needs they would be choosing a more expensive provider, then they will be penalised for this.
They further emphasise this when they say that all NHS Trusts will become Foundation Trusts irrespective of whether this is what they want. They say this is essential because it will “help open the NHS social market up to competition”
So much for “choice and control”.
Those of us who have little confid3cen in or GP services, particularly their opt out from out of hours services, have real and tangible worries about their abilities to became Commissioners. It seems likely that the economies of scale will mean that these will be very large, covering large geographical areas, and losing any neighbourhood focus, which we are told, is what is driving these changes. Putting the likelihood of bought in financial advisers, it is difficult to see how the new NHS will be less bureaucratic.
A highly likely outcome of all this is that international ‘health providers’ will see an opportunity to enter the “NHS social market”. In time their shareholder pressures will drive at least some Consortia to scale down the service they can “afford” to purchase.
The government will then have to decide whether to bail them out or to see this as the time to “consider” whether “some” privatisation might not be 'desirable'.
I am very doubtful about this. Nihat - I have to confess I'm not sure I understand exactly all the points you are making, but that may well just be my ignorance! My concerns on a practical level, in brief:
On a bigger level I share other people's concerns that this is a massive change that seemingly hasn't been adequately tested as a way of working. Does anyway know if there are schemes that approximate to this on a smaller scale anywhere in the uk? And of course I have concerns about the impact of the private sector making greater inroads into the NHS and the profit motive taking more of a role.
Lansley seems to have forgotten that major organisational changes cost (a lot of ) money in the short term - they are impossible to implement without investment, unless there are major cuts in services. Perhaps the latter is the real agenda?
Seems like you might get a chance to tell Andrew Lansley what you think about the white paper yourselves, because he's touring the country seeking opinions.
Meanwhile, UNISON are taking the government to task for getting on with it without first consulting people.
Claire Rayner's final words seem pertinent here: "Tell David Cameron that if he screws up my beloved NHS I'll come back and bloody haunt him". Shame she won't be around to help us defend the NHS against these changes.
Most organisations representing Health professionals seem to be saying "slow down" and "talk to us first". Like his New Labour predecessors, I'm not sure that Lansley is listening. Ideology seems to rule over practicality.