Lansley’s plans will stitch up the NHS

The NHS is one of Britain’s most cherished institutions – pretty much the only thing Labour and the Conservatives agreed on during the general election was the need to safeguard the NHS from budget cuts. It has gone through one of the biggest spending increases in it’s history.

Yet, despite everything, the NHS is, to put it mildly, mediocre. It scores worse than most developed countries’ systems on survival rates and life expectancy.

Furthermore, it is one of the most socialised healthcare schemes in the world – even continental Europe, traditionally much more socially democratic than the UK, has healthcare systems that have more independence and significantly more private involvement.

Most countries have a healthcare market where providers compete for patients by offering better services. This model appears to have inspired the proposed reforms put forward by the Secretary of State for Health Andrew Lansley. The Cabinet minister’s reforms are based on delivering the advantages of market–based mechanisms while retaining the system under state control. The administrative monoliths that are Primary Care Trusts and Strategic Health Authorities would go, with the money being channeled instead into the GPs.

Devolving spending power to the GPs seems like a good idea; GPs will be able to “pick and choose” between various providers of healthcare in order to pick one most suitable for their individual patients, and the most cost–effective. In theory, this would create a market which would drive down costs and improve performance.

But there have been concerns raised about the system, not least by GPs themselves. Many GPs feel that they already have too much on their hands, and juggling a significant health budget isn’t exactly high on their current list of priorities – so they will have to hire a team to handle the budget. In other words, managers. The very people who the Tories are trying to cut out of the loop by abolishing PCTs and SHAs.

With cost the driving factor, quality of care will suffer. Private providers can compete on the same level as public hospitals, which should provide an incentive to strip and pare down costs, or to reduce waiting times.

But stripping down costs means that many GP consortia might avoid paying for patients to have more expensive surgeries done, meaning reduced access to hip replacements and other quality-of-life treatments that many patients have access to now. Furthermore, many private providers will only ever try to compete with the public hospitals on things that can turn them a profit, leaving the existing public providers to pick up the ball on more expensive or less profitable surgeries.

And every contract won by private providers means money that used to go into providing for the public hospitals now going elsewhere. This, in effect, means a budget cut for many hospitals, with some reports saying that dozens of hospitals could be forced to close. Of course, because many of these hospitals would be in rural areas with no other health facility in the immediate vicinity, they would have to remain open – and that would be at government cost. This could all get expensive very quickly.

NHS reform is needed in order to face the upcoming demographic changes and to bring the UK in line with the rest of Western Europe.

Reforms are needed, but Lansley’s fails on many accounts: patient choice is still extremely limited, as it is highly dependent on what their GPs will offer them and would probably even suffer given the need of GPs to cut costs. Private competitors will underfund existing health services, and the “market” would lead to a re–focusing of healthcare towards saving money, rather than, say, curing the patient.

There really is no easy way to re-shape and improve the NHS, but a half-arsed step, which brings in a mixed market and basically strips public hospitals of their money and gives it to private healthcare providers is worse than doing nothing at all.