NHS reforms caught in a ‘reality gap’ as dissent grows
pharmafile | March 31, 2011 | News story | | Andrew Lansley, Liberating the NHS, NHS, NHS reform
The proposed NHS reforms are in danger of failing because of a ‘reality gap’ between the government’s ambitions for change and a practical plan which is ‘opaque’ and ‘too optimistic’.
This is the warning from the NHS Confederation, which has just published its own recommendations to help resolve the problems around the legislation currently going through Parliament.
It says the plans are ‘increasingly controversial’ and cited the motion at the Liberal Democrats conference which called the reforms a “damaging and unjustified market approach”.
The Confederation itself has stopped short of condemning the reforms, but says the government needs to address widespread concerns about specific elements of the Health and Social Care Bill, and is worried that the uncertainty generated is destabilising the NHS.
Nigel Edwards, acting chief executive of the Confederation, commented: “There is a recurring theme running through our analysis.
“We have often found a reality gap between ideas that are good in principle and the details of practical delivery, which have often looked opaque or too optimistic.”
Points of concern
The Confederation says there are four major areas that have become common themes in the criticism of the reforms.
The first is the issue of competition in the NHS, which many fear will lead to privatisation of provision and fragmentation of services. Health secretary Andrew Lansley was forced to amend the Health and Social Care Bill in March after the term ‘any willing provider’ caused widespread condemnation for widening the scope for external, private services to enter into the NHS.
It now reads as ‘any qualified provider’, a fairly ambiguous term that has still not satisfied those concerned about creeping privatisation.
The second issue concerns GP consortia, the new groups who will take over commissioning responsibility in 2013. The Confederation says there are fears consortia will be stretched beyond their current capabilities, and create “serious conflicts of interest”.
The third area concerns arrangements for accountability in decision-making in the new system, and fears they are “inadequate and insufficiently democratic”.
The fourth is the risks in the transition, and fears these are too great given that the NHS must also produce £20 billion in efficiency savings by 2015.
Edwards says a major reorganisation of the NHS combined with these financial pressures had created a “mammoth agenda” and the dangers of distraction for managers “were obvious”.
Health secretary Andrew Lansley has already made several significant concessions and could be forced to moderate his radical reforms even further.
Among its many recommendations, the NHS Confederation says the government could reconsider abolishing PCTs and SHAs in 2013, and instead allow them to remain for longer to allow GP consortia to allow a more controlled hand over of power.
Lib Dem peers have promised to ambush the Bill when it reaches the House of Lords in the next few months. The Conservative – Lib Dem coalition government will be eager to prevent any division between them if at all possible, and Prime Minister David Cameron and Lib Dem Deputy Nick Clegg are reportedly set to discuss possible amendments to head off any such confrontation.
Ben Adams
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