Prof. Ian Shaw ~ It’s starting…

ishaw2It was only 3 short years ago that the White Paper was published aiming to establish a National Care service, free to service users. That was at a time when the recession had started and the Coalition Government had been formed. Now it looks like a completely different world with not a free service, but a cap to social care costs to be established locally in what many commentators are calling a `dogs dinner’ that will lead to multiple challenges and court cases for local authorities.

But it doesn’t stop there… The NHS Confederation (who are meant to be one of the `good guys’) has this week (18/3/13) published a report which contains amongst its pages a suggestion of introducing charging to see a GP out of hours and to charge patients for home visits by GPs and by community nurses.

It’s not just the NHS confederation, the Daily Mail has also latched onto the idea and has included charging patients for their meals while in hospital.

It’s not surprising that the Twitter lines were burning last night in response to this and Roy Lilley blasted the idea as `What Were They Thinking’ (or more likely weren’t thinking) in his blog. One thing that Roy didn’t pick up on – surprisingly for him – is that the costs of the pointless NHS reforms that come into force on April 1st are estimated to over £1 billion in redundancy payments alone and that doesn’t include all the other costs of the NHS reorganisation… it seems patients are being asked to pay for that.

The government has recently had to hastily re-write Section 75 of the Health & Social Care Act 2012 regulations, the first draft of which would have forced commissioners to open just about every part of the NHS up to private sector competition. Following howls of protest from almost everyone. The re-write though was rushed, botched, and there are significant concerns about its intent and how it will be implemented. In particular, there are concerns that the fear of litigation on CCGs if they don’t open up to the market will ensure they do anyway.

The NHS was born out of a long-held ideal that good healthcare should be available to all, regardless of wealth. At its launch by the then minister of health, Aneurin Bevan, on July 5 1948, it had at its heart three core principles:
– that it meet the needs of everyone,
– that it be free at the point of delivery, and
– that it be based on clinical need, not ability to pay.
– Publicly funded out of taxation

Despite earlier reassurances by The Kings Fund to the contrary, it seems these founding principles are coming under attack….

Ian Shaw, Professor of Health Policy, University of Nottingham (19/3/2013)

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2 Comments

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2 responses to “Prof. Ian Shaw ~ It’s starting…

  1. “howls of protest from almost everyone”… but little more, unfortunately.

    The reaction has largely been made up of people stomping around Twitter and throwing their arms up in disgust whenever anybody mentions “user charges” or “competition”. Lilley’s “blast” misrepresented what the Confed actually said. The media have been no better.

    User charges and competition aren’t bad things in their own right and don’t necessarily threaten the NHS’s core principles. Acting as if they do really undermines the howlers’ arguments. There’s a need for more common sense. What are the real implications for health outcomes and the quality of care? And what alternatives do we have to offer? Otherwise it’s just ideology and we may as well be screaming at the Wailing Wall.

  2. Ian Shaw

    I think Clare Gerada – Chair of the Royal College of General Practitioners – addressed these issues in her recent speech: http://library.constantcontact.com/download/get/file/1102665899193-1254/BMJ+HealthSocial+20+Marchwithoutfootn.pdf
    The reforms and quality of care are not synonymous.

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