NHS reform and the return of the postcode lottery

By Tom Keeley

My objection to the coalition’s reform of the NHS is not ideological, which surprises me. I have tried to find something in the White Paper on health to pour my ideological, left-wing anger over. But honestly, I have found very little. My objection is almost entirely on practical grounds.

The NHS does not need another untested, root and branch reorganisation. Doing so on this scale and at a time when real term funding has been substantially cut, means that the future of the NHS is in the balance. The Tory claim to be the party of the NHS has never seemed more hollow. These reforms will mean an NHS in turmoil for the foreseeable future, resulting in the needless death of patients.

The postcode lottery is back. There is no doubt that these reforms will mean variable provision of health care on a geographical basis – that is what they are meant to achieve. As a country our health needs differ between regions and health provision should therefore respond to this. The theory isn’t wrong. With clear oversight, required minimum standards of provision and skilled managers this can be a success. This is exactly what Primary Care Trusts did, overseen by the Strategic Health Authority.

The real concern here is that GP consortia will be of varying standards and accountable to no-one. In my city of Birmingham, GP practices vary in size and proficiency. There are the large multi-partner, highly professional practices, running fantastic community health schemes and who would be very capable of running a consortium. However, there are also many practices that struggle to achieve the basic requirements of their Quality and Outcomes Framework. These failing GP practices, which will soon make up failing GP consortia, are normally found in the most deprived areas of the country. Therefore the postcode lottery will be in standard of care and affect those that need the NHS the most.

A cut in funding and the neutering of NICE. The coalition claims to have “ring-fenced” NHS funding – they have not. The demand for healthcare in the UK is increasing rapidly, due to an aging population and an awful national diet. For the NHS to be able to continue its current level of provision, funding needs to increase year-on-year, at well above the rate of inflation. Therefore the microscopic increase in spending over the next few years will inevitably mean frontline services being cut.

Furthermore, the NHS cost control mechanism, which has worked well since its introduction in 1999, is to become just an advisory body. The National Institute of Clinical Excellence is responsible for priority setting within a manageable budget. The government has not been clear on how exactly priority setting will occur in future, but the inevitable consequence will be that the NHS will pay more for less, at a time when money is tight.

Untried and untested. One of the failings of Labour’s stewardship of the NHS in the early 2000’s, was the implementation of untested policy. In the main, talented NHS managers and the availability of money made these reforms workable. This policy, which is more sudden and wide-ranging than any of Labour’s reforms, is totally untested and without precedent. This time the talented managers will not be leading the reforms and money will not be available to throw at the problem.

The strongest grounds for the rejection of the health reform are not ideological. They are the practical. This health reform is poorly conceived. We should be saying that “mothers and fathers will lose sons and daughters to illnesses that could have been cured, because the coalition has not thought this through”. We should be saying this because that is what happens next.