An ill wind?

Possibly the main concern about the forthcoming NHS reforms among doctors (or at least those that give a shit) is that it will lead to a deterioration in patient care. That introducing the private sector will give financial considerations too much emphasis, and that the drive to provide health as cheaply as possible, driven by the need to compete and maximise profits, will put quality of care a very poor second.

There is an analogy here with the roadside assistance organisations, the AA and the RAC. I remember when these organisations were rather like clubs. When you needed them their first priority was service, not profit. Then they were bought up and became insurance companies, and my perception is that the service has plummeted. I have twice called out the RAC in the last 3 years. On one occasion I was told to expect a 5 hour wait, and on the other I was told that the problem was “not covered” 

The new bill will not really affect the delivery of primary care. It’s main effect will be on how GPs acquire secondary care for their patients and this is where the potential lies for a financially driven deterioration in service.

There could be rationing of care as contracts become filled. There could be lengthening waiting. There could be money saved by getting work done cheaply by less qualified people, increased reliance on inflexible protocol lead care, reduction in staffing levels, and less involvement of consultants, despite this being the gold standard of care.

Oh wait, we have got all that already, in the current system of the NHS. Could the new system really make things worse?

I have a little experience of working in an Independent Sector Treatment Centre. Recent evidence suggests that they actually have better results than the standard NHS, though obviously there are numerous factors at play. The main factor is that the patients are cherry picked, reasonably fit, and having very routine care. But another factor could be that they only employ Consultants to do the work. No trainees, no acting up nurses, just patient/consultant contact, from start to finish. 

There is no doubt that, like it or not, the reforms are coming. The medical profession over the years has suffered numerous NHS reorganisations, and has always managed to produce a silk purse from a pigs ear. The front line staff have always managed to make the system work for the benefit of the patients despite their misgivings. As Patton once said, “when you leave people to get on with the job you will be surprised by their ingenuity”

Ultimately whether the NHS survives or goes tits up depends, not on the politicians, but the front line staff. And that is why I am less worried than some. It is a question of where, and in whom, you put your faith.