Sunday, 3 April 2011

A "pause" for NHS Reforms: Can the Government afford a U-Turn?

An article over at the Independent claims that the Prime Minister, David Cameron, will this week announce a pause in the radical NHS reforms currently going through Parliament. This comes following increasing criticism over the past few months from the Public, doctors, nurses, unions, MPs and virtually everyone else who has an interest.

The delay, expected to last about three months, will be used by Cameron and Lansley to further press the need for the changes and to reassure worried parties of the integrity of the plan. Cameron, who has styled himself as a champion of the NHS, especially wants to dismiss fears of privatisation.

Hopefully, if the reports are true, this won't just be a matter of reiterating what has already been said. It's safe to say that GPs and other health professionals have a strong grasp of the nature of the reforms by now and simply telling them it all again won't do any good. The pause needs to be a period of true engagement; the sort that was promised with the 'consultations' between last summers white paper and the bill being introduced in Parliament, but never quite materialised.

As we discussed in an earlier article, a lot of ill feeling has come about because the concerns raised in those consultations appeared to have had little to no bearing on the resulting Bill. Doctors, amongst others, were angry as they felt that they weren't listened to. If the same happens again, with Government restating what's going to happen, without being open to changing it's plans in response to feedback, then the pause will only make things worse, further infuriating stakeholders.

However, if significant changes are made to the plan, there is a problem that is rarely mentioned in articles predicting a u-turn on the reforms. That problem is that to a large extent, the reforms have already been put into motion. Well over 50% of the country is now in the hands of "pathfinder" GP Consortia. Initially these were proposed to test the changes, but seem to have been rolled out further in anticipation of the Bill being passed. Many PCT's have also been merged, in preparation for their abolition.

In a time of austerity, with the NHS overhaul being ostensibly about saving money, the cost of implementing all this, only to have to change the system back again, would be a tremendous waste. Initiating reform before it's ratified will perhaps be a lesson for the Coalition in not counting chickens before they're hatched.

It would seem that the Government really cannot afford for their Bill to fail in Parliament, but unless they meaningfully respond to feedback and make changes were necessary, the threat of striking doctors, public demonstrations and rebelling MPs, may prevent any other outcome. A Government Bill hasn't been defeated since the Shops Bill in 1986, but then, there's never been a bill proposing such radical restructuring of the NHS before.

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