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The new Health White Paper - worth the paper it's written on?
posted at 13/7/2010 3:17 PM BST
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Posts: 468
First: 15/11/2008 Last: 28/3/2012 |
Yesterday, the Health Secretary announced his new Health White Paper for the NHS in England which sees a signifficant shake up, including a move to hospitals stepping outside the NHS to become a vibrant industry of social enterprises, 500 consortiums of GP practices with access to £80bn to spend on local services and greater choice and information for patients. Without pilots of these new changes, is the Health Secretary taking a giant leap as opposed to small steps and are those who are to be empowered with spending and choosing services equiped with the necessary skill set? Apparently if you get it wrong there will be no bail outs so one shot is all you appear to get. SHA's and PCTS are set to be axed so potentially skilled workers could move into new positions, but as with all professions, it takes time to aquire knowledge and gain experience so maybe he is asking for too much, too soon and where the budget deficit is concerned, too late???? |
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Re: The new Health White Paper - worth the paper it's written on?
posted at 13/7/2010 5:07 PM BST
on bmj.com
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*Moderator*
Posts: 665
First: 13/3/2009 Last: 10/4/2012 |
WIll GP commissioning be good for patient care? That was the debate at this morning's BMJ planning meeting. The last time we had anything resembling this was in the early 1990s, when the then Conservative administration pushed GP fundholding. But that was a bit of a damp squib. Certainly some entreprenurial GP practices embraced is wholeheartedly and tarted up their premises, but the model was unsustainable and inner city single handed GP practices were left behind.
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Re: The new Health White Paper - worth the paper it's written on?
posted at 13/7/2010 5:41 PM BST
on bmj.com
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Posts: 226
First: 27/6/2009 Last: 21/3/2011 |
Prof Allyson Pollock raises some dystopian but very valid concerns about the white paper enabling privatisation via the back (or even front) door. If this is the case, patients with chronic diseases and mental health issues i.e. those with the greatest need but often the least vocal, may be worst hit. Until some of the fine details emerge though, there'll be plenty of fuelling the fires of fear! |
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Re: The new Health White Paper - worth the paper it's written on?
posted at 13/7/2010 8:51 PM BST
on bmj.com
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Posts: 888
First: 12/11/2008 Last: 2/5/2012 |
The idea that GPs can choose services better than PCTs/managers seems appealing at first but what does it actually mean? I dont see how having 500 groups nationwide deciding on services rather than 150 PCTs will be any more GP driven than it is at the moment. Does anyone else? |
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Re: The new Health White Paper - worth the paper it's written on?
posted at 13/7/2010 9:32 PM BST
on bmj.com
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Posts: 67
First: 2/6/2010 Last: 28/5/2011 |
My understanding is that this move means that now the health service should be more driven to the patient and medical needs as who knows better what's needed than the GP's, however is this just a way of saying to the current managers that they aren't doing a good job as patient needs aren't being looked after? Or are they doing a good job already and we're just shaking things loose for the sake of it. |
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Re: The new Health White Paper - worth the paper it's written on?
posted at 14/7/2010 1:06 AM BST
on bmj.com
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Posts: 124
First: 11/6/2010 Last: 1/4/2011 |
Although the reforms accompanying the handing over of power to GPs were alluded to in the question they have been missed out in the discussion. “The biggest shake-up in decades,” comes with various other changes such as allowing NHS foundation hospitals trusts to leave the state sector and a scrapping of the food standards Agency. I think it is extremely difficult to make a huge overhaul to the NHS and get it right first time. The creation of the NHS is one of the only examples of a success in such a situation, but we are still trying to sort out its problems. MTAS is an example of how easy it is to get it wrong, another example of radical change without proper planning, leading to a huge money loss. At a time when the government is cutting millions on frontline services, can we afford to be making such a gamble?Max Allenhttp://max-allen.blogspot.com |
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Re: The new Health White Paper - worth the paper it's written on?
posted at 14/7/2010 11:22 AM BST
on bmj.com
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*Moderator*
Posts: 665
First: 13/3/2009 Last: 10/4/2012 |
Shouldn't they just leave things alone? Are they really that broken? The endless reorganisations the NHS has had to face over the years must have cost billions - most of that money could have gone on patient care. Lancet editor Richard Horton makes some very good points in a letter to today's Times:
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Re: The new Health White Paper - worth the paper it's written on?
posted at 14/7/2010 12:22 PM BST
on bmj.com
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Posts: 141
First: 22/7/2009 Last: 14/2/2012 |
Think I may have just mis-posted so apologies if this appears twice… But please God spare us from another NHS White Paper. “Equity and excellence: Liberating the NHS” (catchy title by the way) comes to us in association with 2008’s “High quality care for all”, 2006’s “Our health our care our say”, 2004’s Trainspotting inspired “Choosing health”, 2002’s “Securing our future health” (featuring exclusive 2004 Wanless remix), 2000’s “NHS Plan”, 1997’s “The New NHS”, the letters Y, O, Y and the number 666. And that’s without even mentioning some of the other best loved tracks from the Department of Deckchair Reshuffles including regulatory favourite “Trust, assurance and safety” and the much unread “Pharmacy in England”. And not only that but it turns out that this latest “radical, once in a lifetime, shake-up of the NHS” is actually just a reissued version of 1991’s “fundholding is the key” and 2005’s less bought “practice-based commissioning is going to save you”. I’m just feeling a little cynical this morning…
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Re: The new Health White Paper - worth the paper it's written on?
posted at 15/7/2010 10:39 AM BST
on bmj.com
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*Moderator*
Posts: 665
First: 13/3/2009 Last: 10/4/2012 |
That's OK Ed, cynical is good. You're hiding your light under a bushel here. You wrote a rather good BMJ blog on this very issue after being fired up at the NHS Confederation conference. I was interested in David Aaronovitch's point in today's Times. Was there any mention of this massive proposed NHS upheaval in the election manifestos, he asks. He certainly didn't spot any, and wonders if there had been, might it have lost the Conservatie Party votes? Steve Field, Chair of the Royal College of General Practitioners, also weighs into the debate in the paper's letters pages. He says the White Paper's proposals could deliver a "clinician-led health service" and the professions have been calling for this for years, and that given the right level of support, GPs can make a success of this.
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Re: The new Health White Paper - worth the paper it's written on?
posted at 15/7/2010 7:14 PM BST
on bmj.com
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Posts: 15
First: 2/4/2009 Last: 13/11/2010 |
I agree David Aaronovitch's column in the Times set out the gulf between what was in the manifestos, specifically ruling out major reorganisation, and the radical reorganisation we now confront, but he doesn't seem to express a view on it. In reality, we will now spend three years scrapping old organisations and recreating them under new banners. We'll have consortia of GPs setting up their own commissioning structures and will need commissioning experts to do this. The consultancies will bloom again, and good PCT staff will find jobs in the new structure - unless the best leave in disgust for other jobs in other sectors. Similarly, the regional offices of the NHS Board will attract some from the SHAs but the best will likely go elsewhere. This is a brilliant exercise in how to occupy the workforce with rearranging the deckchairs, while distracting the whole NHS from the real task of improving or defending quality in the face of a real terms financial downturn. |
