Thursday, 28 January 2010
Conservatives NHS Autonomy and Accountability Proposals
It is clear that if the Conservatives gain power they will make changes to the structure of the NHS. The Conservative 2010 "Draft Manifesto" on health gives some clues, as does their policy paper called the Health Improvement Plan. In this blog post I will gave another source of information about what the Conservatives plan for our NHS. In 2009 the Conservative party published the NHS Autonomy and Accountability white paper which is essentially the first draft of the first NHS bill that a Cameron government would present before Parliament. Team Cameron regards the NHS as a moving target, they focus group regularly and use this to make reassuring noises to the Press. However, underlying their public pronouncements are the real Conservative policies for the NHS: a vast expansion of the private sector, financed by the "ring fenced" NHS budget. In this blog post I will provide more evidence of this privatisation plan.
We know that the Conservatives have a dislike for NHS providers. We know this because the "Draft Manifesto" avoids pledging any commitment to existing NHS providers while at the same time it is enthusiastic about the "new providers" that will be created. In a time of austerity (and probably economic depression caused by Conservative mismanagement of the economy) what business will want to start up in Britain? Well, if the business is guaranteed contracts from the NHS, and backed by substantial amounts of public money from the "ring-fenced" NHS budget, any business will be able to secure capital funding from the money market. This guarantee of business for such private providers is given in the Conservative white paper:
3.1 Patient choice needs to be supported by a powerful system which offers rewards to the best providers. We believe that the best way this can be achieved is by allowing money to follow the patient to the provider of their choice.
This statement does not say NHS provider of their choice, as is the case at present. This means that NHS money will go to the private sector, with the corollary that NHS providers will not get this funding. This sentiment is reiterated later in the document:
5.5 Alongside NHS Foundation Trusts, which are public benefit corporations, we will enable any willing provider, who is able to meet NHS standards within NHS tariffs, to offer services to NHS commissioners.
I should make it clear here. The NHS is already under budgetary constraints and Cameron's "ring-fence" will not change this. The NHS is efficient, but it does rely on a regular income. If some of the budget is diverted to the private sector, it could have a catastrophic effect on existing NHS providers. Cameron knows this, yet he continues with his plan to allow NHS budgets to be spent on private care (note that these are not only existing private providers, but are new providers, that is Cameron expects the private sector to increase). The only conclusion that can be drawn is that Cameron wants NHS providers to fail and wants top see a shrinking of the public providers. His rationale is given in the following statement:
4.1 Allowing money to follow the patient to the provider of their choice – as under payment by results – will help to drive improvements in the responsiveness of services to patients.
The Conservatives are obsessed with the idea that by taking money away from a service you will improve it. It is very clear that if you take money away from a service the service will fail. The service users, if they are lucky, will have to obtain the service from elsewhere. The problem is this attitude of "if the hospital has problems close it down" is a very blunt tool, especially when there are better, more efficient and less costly ways to improve NHS services.
We know that information about hospitals is already published. There is the NHS Choices website for patients' reviews, and the CQC website for official healthcare quality reviews. In addition, there is also third party analysis available from Dr Foster Intelligence. So patients already have information about the NHS provider that they will use. However, the Conservatives want more, they even want hospitals to advertise how good they are:
2.31 Though simply allowing patients to choose where they are treated will drive improvements in the information provided to them – for example, hospitals will unilaterally seek to highlight to prospective patients why they should be chosen over other hospitals – we recognise that this process may not go far enough, fast enough.
This clearly says that under the Conservatives' plan that providers will advertise highlight the reasons why patients should choose them. Imagine how this will develop. Hospitals will have to create marketing departments (and a marketing budget – money that should go into healthcare). Our newspapers will have adverts from all the hospitals in your area, and local TV and radio will have adverts from the larger hospitals. This really is the creation of a market in healthcare.
So what sort of services will David Cameron's NHS deliver?
4.32 Alternative contractors, if they are able to demonstrate to the PCT that they can provide the necessary combination of primary medical services and commissioning skills to deliver the highest standards of care for NHS patients.
That's right, Cameron intends to allow NHS money to finance so-called "alternative medicine". I should now point you towards what Tim Minchin says about alternative medicine:
"Do you know what they call 'alternative medicine' that's been proven to work? Medicine."
Please, Dave, give us medicine, not unproven, placebo quackery.
Further, where will patients have these treatments? The first indication is given in this statement:
3.10 We support the return of powerful, clinician-led commissioning in primary care – like that engendered by GP fundholding in the 1990s.
Studies of the disastrous scheme of GP fundholding in the 90s have shown that GPs who have fundholding are less likely to refer patients to specialists (note that word: specialists, the people who best know how to treat you) than those GPs without fundholding. It is concerning that the Conservatives want to return to a system that was designed to prevent patients from being treated by specialists. Specialists are hospital-based, so this again shows the lack of commitment the Conservatives have to NHS hospitals.
But the Conservatives go further:
4.35 Patients will be entitled to exercise choice in elective care, in community provision where possible, and in respect of treatment options where appropriate – provided that the options are cost- and clinically- effective.
This, yet again, indicates that the Conservatives do not want patients to be treated in NHS hospitals. Expect that under a Cameron government your local NHS hospital will close.
So what do the Conservatives have planned for existing NHS providers: your local hospital?
5.13 However, such partnerships will be strengthened if NHS Foundation Trusts can offer their own assets as security on loans, together with sound long-term business plans based on the stable framework of regulation outlined above.
This is very concerning. NHS hospitals will be expected to pawn their property to obtain capital funding. Can you imagine what will happen when a hospital, forced by falling income due to Cameron's any willing provider policy, defaults on its bank repayments? Yup, the bank repossesses the hospital. A frightening prospect. The sentiment is given elsewhere in the white paper:
5.4 To maximise the freedoms of NHS Foundation Trusts, we will lift the restrictions on borrowing secured against their assets and remove the prohibitions in the NHS Act which restrict their capacity to secure private income.
This gives another worrying policy: the Conservatives say that NHS hospitals should take private patients. This can only mean that there will be a two tier system, otherwise why would private patients pay extra, if they are not getting something extra for their money? NHS investment should be solely for NHS care, private patients should not benefit from public money.
The future of the NHS is very bleak under David Cameron. The Conservative white paper reads as a recipe for privatisation: NHS hospitals will have to advertise their services, they will only get funding by pawning their assets, they will provide private care which heralds a two-tier system. If you value the NHS, the quality and equality of its services, then the answer is clear: vote for a Labour government.