NHS Reforms – Power to the People
Or rather power to the people’s GPs. Sounds like an excellent idea. Give the money and the power to those people closest to the “end user” (you and me). The GPs. We all know the NHS needs radical reforms. More managers than doctors and nurses, more employees than the Indian National Railway, overpaid and underperforming management. So the current proposals to remove a layer of “bureaucracy” must be a good thing surely.
The PCTs and their ilk add an unnecessary layer of bureaucracy, cost and inefficiency to the process. Remove them and place power and decision making back with the GPs and all will be well with the NHS world. Money will be saved by the lorry load, and patient services will be improved. Give Patients choice – more power to the people. Yes please.
Or Maybe Not…
As with all seemingly well intentioned ideas a little further scrutiny reveals some potential flaws in the logic. Firstly let’s talk about the idea of patient choice. As with education, the idea that everyone wants a choice over what care they get from whom and where is in my humble opinion flawed. In reality what people want is to get the best care available as close to home as possible. They expect their local GP to know what this is and where to get it, not to be given various options and have to do the research themselves. Universal healthcare, like universal education, should do what it purports to do on the tin – offer everyone the best that is available.
Secondly let’s look at the idea that GPs are best placed to make choices and decisions. Logic dictates that by devolving decision making to multiple centres the amount of duplication, overlap, and therefore cost, is likely to increase. Never mind the fact that, again as with teachers, we’d much rather our doctors were helping their patients, not administering and managing. The idea that GPs surgeries will all club together to do this is wonderful, but ultimately that idea was exactly what the PCTs were doing in the first place. I’m sure there is room for cuts within these, and I’m also sure that the staff are often paid far too much for what they do and deliver – therefore make them more efficient, don’t scrap them completely.
Above all I am a firm supporter of the view that introducing yet another major overhaul of the health service will ultimately just lead to further reductions in levels of service, even greater costs (even if they are moved from direct staff costs to indirect external costs), and of course massive implementation costs and fees for the army of external consultants and advisers who will be “needed” to make it all happen.
So what’s the solution?
Why should the NHS be any different from any other department in the current climate. Set them a target for reducing their costs. Each area should perform a bottom up review of their cost base with a view to reducing costs at all levels. In reality the NHS, behemoth that it is, should have massive negotiating power on the prices it pays for services and goods, all fo which is removed at a stroke by devolving those decisions to a local micro level.
Of course the other area that needs addressing is the salaries and pensions of the staff. GPs themselves managed to negotiate the pay deal of the century under Labour with massive increases in salary tied to removing out of hours cover. Nice. So what exactly do the government expect when they are asked to do all this additional work? the good news is that a career in medicine is no longer a vocation, it is quite simply one of the most lucrative careers available (outside politics of course…).
So please think again Mr Lansley. You’re in danger of introducing more cost, greater chaos, and above all lower levels of service to the people who all this is intended for – us, the patients. Just aim for the same 25%-45% savings levels for the NHS are you are with the other public sector cuts. Slash the salaries of the top earners, introduce pension reform, leverage the buying power of the largest employer in Europe, and slash external cost.
Just a thought……