Patient-led NHS revolution to continue, says under fire Hewitt
pharmafile | January 18, 2006 | News story | |Â Â Â
Patricia Hewitt has pledged to press ahead with the next phase of Labour's NHS reforms, despite renewed opposition from within the party, and worsening financial problems in the health system.
Addressing health service managers at an NHS Confederation meeting, she said dramatic improvements had been made to patient care since the 1980s and 1990s, but that further change was necessary.
"Now is the time to increase the pace of reform and to widen the scope of our ambition because we are within sight of an NHS where patients' demands and aspirations will be the key driver towards better, faster care and greater efficiency and value for money.
In a term of office full of revolutionary reforms to the NHS, Labour's latest is the introduction of patient choice in elective surgery, introduced on 1 January.
While some within the service have misgivings about the choice agenda, Hewitt confirmed that patient power would soon be unleashed on other parts of the NHS.
"If NHS staff think that ministers are demanding, just wait until the patients are in charge. That is our goal – an NHS which looks outwards to the people it serves, not inwards to politicians."
In fact Hewitt's speech contained no new policy directions, only extending the ideas formulated before 2005's election – patient choice and the twin engines of reform, practice based commissioning and Payment By Results. The latest policy update Health reform in England: update and next steps, does however, introduce a new term for the policy – a 'self-improving' NHS.
This is defined by the "highest possible quality of care, delivered in the most efficient way, led by the needs and wishes of patients." The DH document adds: "Such an in-built dynamic for continuous improvement is essential to enable the NHS to keep pace with fast-changing technology, to tackle inequalities and to raise standards of care."
One area of 'fast-changing technology' is of course the development of new, more effective and more costly medicines.
But controversy over access to cancer drugs like Herceptin – and Hewitt's direct intervention at PCT level – has demonstrated the NHS is still far from the governments 'self-improving' ideal.
The existence of widespread financial problems across PCTs, strategic health authorities and acute trusts has made progress on this issue even more difficult with indications that prescribing cutbacks are being made to reduce trust deficits.
While pharma companies will naturally object to such moves, the media has picked up on more easily comprehensible cutbacks such as the John Radcliffe hospital's decision to stop providing cardiac ablation surgery.
But Noel Staunton, a prescribing consultant to the NHS and industry says trusts see prescribing as an easy target to reduce budget overspends, and are using two main methods to cut costs.
"Prescribing always seems to be seen as the low hanging fruit for cost saving and not as something that can save the NHS money downstream.
"There are two ways of saving money commonly used – switching between drugs in the same class in primary care and blocking or delaying the uptake of expensive new drugs in secondary care.
"You would hope that in the medium-term PCOs would change their views on prescribing, and not just see it as a way of saving money."
Labour now needs to win public confidence in its reforms more than ever in the face of a resurgent Conservative party.
Blair's government has had little trouble convincing voters its policies are superior to those of the Conservatives, with opinion polls showing Labour's NHS policies helped it secure a third term.
David Cameron has continued his dynamic start to his leadership of the Conservatives by abandoning the unpopular policies which encouraged uptake of private insurance, and pledging his support of a free and equitable NHS.
"Under a Conservative government, the NHS will remain free at the point of need and available to everyone, regardless of how much money they have in the bank," he said.
He added that patients would become increasingly better educated and better informed about their health options, using the internet in particular to find out about the best treatments.
Moving to more 'centre ground' policies could pay off for the Conservatives, but Cameron will have to persuade voters his party can deliver a similar agenda more effectively than Labour.
Displaying some detailed understanding of healthcare issues – and an eye for popular appeal – Cameron touched on the issue of access to new medicines.
He predicted patients would become increasingly better educated and informed about their health options, using the internet in particular to find out about the best treatments.
He added: "And new ones are coming on stream the whole time. Alimta, for lung cancer, Velcade, for myeloma. And of course, Femara and Herceptin for breast cancer. The NHS can no longer ration these treatments as it used to. Patients will demand them."
Policies which guarantee greater access to medicines would undoubtedly be popular with the public (and the pharma industry), but having committed itself to the current funding system, the Conservatives will be faced with the same finite and overstretched NHS resources as Labour.
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