Will New Reforms be Make or Break for Cameron?
The new reforms to the NHS brought in by the Tories and Liberal Democrats have arrived and, some say, not a moment too soon. Though some claim that the NHS does not require change, the real issue is whether these particular changes are necessary and whether they are the right way to go about changing an organisation that has always been a symbol of what is great about British society. In essence, can Cameron show that he can be trusted with the NHS?
Unfortunately these reforms cannot be given a snappy summary or inspirational catchphrase like the Coalition’s campaign for ‘making work pay’ in welfare. Indeed, it’s taken a while for the reforms to be properly explained and understood, with Cameron only successfully defending his proposals in early February on the BBC Breakfast show. What these reforms ultimately boil down is the move to establish a ‘GP commissioning consortia’, which will handle commissioning treatment, worth over £80 billion after the government axes two tiers of administration from within the NHS. The consortia will be accountable to a new independent ‘NHS Commissioning Board’, which will allocate budgets and oversee the reformed service.
Can doctors really be expected to provide the best care for patients whilst keeping their hold of the purse strings to their treatment? The Royal College of Surgeons (RCS) has isolated this question as one with which they have a particular concern. They argue that, while they support the government’s aim for finding the best value in health spending, there needs to be greater detail in the proposals if we are to avoid a situation where doctors focus on lowering costs and cause a ‘race to the bottom’, with price squeezing out quality. Furthermore, even if they can fulfill this dual responsibility, is it fair that they should carry the weight of this? While Cameron is keen to establish that individual doctors will not be under individual pressure to make financial decisions, it is worth questioning how much of this claim is merely the classic pitch – the government trying to defend their already highly contentious proposals for the NHS? Even then, though, doctors may not be under individual pressure; the proposals do amount to a group of around just 15 doctors being responsible for a whole borough.
The Government’s Health Secretary Andrew Lansley has argued that these worries are unfounded. Not only is he adamant that while the BMA and RCS have both raised concerns with the reforms, they do have the full support of clinicians who claim that “with rising demands on healthcare and results for patients – like cancer survival – not even at the European averages, the NHS needs to modernise now.” However, stating that the NHS needs reform does not justify the repercussions of these specific changes. What has not been made clear is why this path is the best one for government to go down.
Ultimately these reforms are proving very controversial, especially with influential institutions like the BMA expressing their strong doubts about the speed at which the changes will be made. This being the case, it may seem unreasonable to expect a government with the life span of just five years at to push forward with such ambitious reforms that have such a long-term application period; these reforms may only provide their financial benefits in the next Parliament.
Out of all the changes made by the coalition this will be by far the most important. The consequences will be Cameron’s defining moment as our Prime Minister. Even if the results are catastrophic, he will be remembered for transforming our most treasured and significant institution.