Something of a shock........!


By Leon A Smith
January 21, 2011
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This week has seen the publication of further details of the government’s plans to restructure/reorganise the National Health Service. We hear that the depth and breadth of this proposed restructure has come as something of a shock not only to many people who voted for the Conservative Party but also some of its MPs. The change being proposed is radical, far reaching and not totally thought through!

It seems that it is almost obligatory for a new government coming in to power to talk about changing the structure of the National Health Service!
We have experienced many such changes and upheavals in the past – sometimes a new change is embarked upon before the last one is even embedded in. For people working in the health service there must be an overwhelming sense of de-ja-vu.

The target this time is what is seen as an unnecessary level of bureaucracy. For Primary Care Trusts and the Strategic Health Authorities there is a suggestion that all management, administration and bureaucracy is bad and that we don’t need these stratum of management.

Although one can see the political value of announcing vast efficiency savings – in this case approaching £2bn per annum, then of course all of this money can be spent on direct care, though one has to wonder will it be? How will it impact on waiting times and the quality of service both in primary care and in more specialist services?

Since the launch of this new plan there has of course been heightened insecurity within the Primary Care Trust, with most people wondering what kind of job security they now have. People are going to have to apply for new jobs which may not be dramatically different from the ones which they are doing at the moment. What they do not have is the peace of mind of knowing definitively that they will still be in employment in say two years time.
In defence of Primary Care Trusts and managers, there is a very large chunk of work which has to be done both in terms of oversight and commissioning of services. This function is largely to be delegated to GP commissioners and a new national commissioning body.

One wonders how this is going to work in practice – and unfortunately any wondering has to be done in the absence of solid concrete information. GPs will have spent many years at university and medical school studying to become clinicians. It is unlikely that much of that time will have been spent studying how to become a commissioner and manager of budgets. The government will tell us that there has to be a change but in reality the only things worth measuring in relation to the proposed changes are outcomes. How are we going to quantify by just how much the service to patients has improved?

It appears that the ongoing insecurity and upheaval, the structuring and re-structuring can only ultimately negatively impact on efficiency and morale and it is difficult not to be sceptical about the true value to the patient of these changes.

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