The signals concerning the future of health care and social protection in the UK are quite confusing. On one side, with the Big Society initiative, the Government seemed to want an opening to civil society participation in the social services, incluin through the creation of mutuals and cooperatives.
On the other side, the recent announcements about the NHS reform seem to indicate a trend towards a dismantling of a system, without any say for the citizens!
- It would leave responsibility of deciding cares and prescriptions to the general practitioners, organized in around 500 consortia, but with a target clearly aimed at reducing costs.
- It would open competition between private and public hospitals with the same aim: cut costs! It could also lead to the closing of non profitable hospitals, which could be a big risk for the quality and proximity of cares … not mentioning the political sensitivness of such measures!
There is plenty of reflexions to be had on this potential reform, which aims in a direction similar to what is happening in France and other countries with the reduction of “social expenses”.
This subject will no doubt be at the center of the meeting organized by the Network and planned in March in Benenden’s Kent Hospital with a French delegation lead by the French Mutual MGEN.
Maybe the End will Justify the Means
Thierry, you are right that opening the door even further to commercial health service providers seems to conflict with “Big Society” ideas for encouraging the greater participation of civil society. However, the principle stated objective of the NHS reforms is to make the NHS sustainable. After Labour’s 10 years of increased investment and quality and productivity initiatives, the NHS is in good health. This may come as a suprise to foreign readers who expect the NHS to be reported in adverse terms, but patient satisfaction rates are high and outcomes are improving. When cost is considered the NHS is also excellent value for money – 8.7%GDP compared for example to France 11.2%GDP (OECD). So what ever the political flavour of government the NHS model itself is worth preserving.
The key to retaining the ethical values of the NHS is to hold politicians to account for the reassurances they offer to those concerned about the effect of incentives and competition. The Health and Social Care Bill is still progressing through parliament and as it does there are more details revealed and more amendments made. It is now clear that the future survival of the NHS depends not only on the ability of General Practitioners to control demand through their role as Gatekeeper but also on their ability to control costs in their new role as Treasurers. Whether they are up to this challenge remains to be seen.