Nicholson warning over NHS reforms

pharmafile | October 17, 2012 | News story | Sales and Marketing CCGs, NHS, Nicholson, reforms 

Sir David Nicholson, chief executive of the NHS, has warned that reform of the NHS could end in ‘misery and failure’ if not handled correctly.

Under the Health and Social Care Act, GPs are taking control of most of the NHS’s budget, forming local Clinical Commissioning Groups (CCGs) to decide how money should be allocated.

But Nicholson said that expecting doctors to be businessmen, negotiating and procuring services rather than focusing on their clinical work, would be a mistake.

Talking at the Royal College of GPs’ (RCGP) annual conference in Glasgow, he said: “If we’re creating a system where GPs think it’s their job to do all of that then I think we’ve got a massive problem.”

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Making reference to his involvement with large-scale IT projects in the NHS, Nicholson continued: “Big, high profile, politically-driven objectives and changes like this almost always end in misery and failure.”

Sir David also warned against ‘carpet-bombing’ the NHS with privatisation – and his comments were seized on by opponents of the government’s NHS reforms, with Labour suggesting it meant the “crisis in confidence in the government’s reorganisation gets deeper by the day”.

“People will be worried to hear the man charged with implementing the government’s NHS reorganisation openly questioning it and predicting it could end in ‘misery and failure’,” shadow health secretary Andy Burnham said.

“We knew there were widespread professional concerns about government plans to turn the NHS into a free market but it is now clear they go to the very top,” he added.

“After David Nicholson’s comments, I am today writing to [health secretary] Jeremy Hunt to ask him to suspend plans to put 39 NHS services out to open tender,” Burnham concluded.

However, Nicholson’s comments at the RCGP debate were more nuanced than have been suggested in some reports. While warning against mass privatisation he also made clear that there were circumstances in which third party providers had improved services for patients.

“Where we have brought outsiders in to solve really intractable problems, a bit of gingering up…from outside, a bit more innovation from outside has made a difference for our patients,” he said.

“So we should always use it as a tool to drive change,” he went on. “I don’t advocate the carpet bombing approach but I do think in [some] circumstances we can show it has made a real difference.”

He also emphasised the opportunities that the creation of CCGs offer, saying that they now had the ability “to play it as they see it” to patients’ advantage in their area. “The existing system has not always done great things for our patients,” he said. “The NHS does not have a monopoly on great ideas.”

And while he acknowledged and shared some concerns about the government’s reforms, he said that the Act had changed the relationship between government and doctors for the better.

“It creates much more difficulty for politicians to arbitrarily get involved in the day-to-day operations of the NHS,” he pointed out. He urged the NHS “to get hold of this opportunity and make it work for the NHS and patients”.

You can see the video of the debate here.

Adam Hill

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