Recent changes to the NHS and the launch of the National Health Action Party
This month has been marked by the launch of the National Health Action (NHA) party. The party has been set up by a group of doctors looking to repeal the current government’s healthcare policy, which they claim is “destroying the NHS”.
The NHA party intends to challenge seats held by leading political figures including Prime Minister David Cameron and Health secretary Jeremy Hunt in the next general election. It has been set up as a direct result of the Health and Social Care Act, which was passed through Parliament earlier this year. The party states that they believe that this legislation “will destroy the NHS in England as an effective, efficient health system fair to all citizens and patients”, and make it “more expensive, wasteful and unequal”.
“People truly have no idea what is going on in the NHS,” claims party member David Skidmore. Just in case you feel as though you aren’t completely up-to-date on current NHS policy, here’s a quick recap. The recent changes were brought in under the Health and Social Care Act. They were described by Dr Clive Peedell, co-leader of the NHA party, as “the most extensive reorganisation of the NHS to date”. Under the Health and Social Care Act, all English hospitals are to turn into Foundation Trust hospitals, semi-independent and equipped with the power to earn money by providing private healthcare alongside normal patient care. A new consortium of GPs has also been formed, who are responsible for the healthcare budget. They are required to commission services from “any willing provider”, under the supervision of the regulator Monitor, responsible for scrutinising behaviour considered to be non- competitive.
Campaigning groups such as 38 Degrees are also speaking out against the changes to the NHS, and are in the process of forming local groups across the country to try to protect individual hospitals as they become more privatised. So what is the source of all this concern? Is it justified? In some ways it is hard to say. Certain changes aren’t set to come through for some months. The translation of the changes from paper to different parts of the NHS will inevitably vary up and down the country. However, many seem to be feel that the effects of the Health and Social Care Act do not look good overall and there appears to be a great deal of unhappiness among certain NHS staff.
The first problem has been an increase in the awarding of NHS clinical contracts to the private sector. This, according to Dr Alex Scott Samuel of Liverpool University, has led to a “reduction in collaboration and integration between services”. Some within the health sector see this strengthened lean towards marketisation as incredibly risky and the evidence for it being cost-effective as dubious.
A second problem that GPs see as an obstruction to patient care, is constant consideration of their budgets. One health sector insider (who prefers to remain anonymous) has commented that “staff are having to spend hours each week worrying about financial matters, when they should be providing patient care”. This has proved particularly challenging, as there are some GPs who “have no experience, expertise or inclination” to be dealing with these budgets. Another insider (who, again, prefers to remain anonymous) describes the presence of “big reputational risk” to GPs, who in making these decisions are seen as “conflicting their role as patient advocate”. There was also mention of the “blatant conflict of interest” in awarding contracts to firms which GPs own part of. This was particularly brought to attention when it was recently reported that five family doctors became millionaires in the same week, from the sale of their NHS-funded firm to private health company Care UK.
The third issue causing recent unhappiness in the NHS is the increased presence of obstructive cost- saving schemes and cuts. “A big change instigated by the reforms has to be the cost” states Mary Taylor, a professional within the NHS, “we were already facing a cut of 20 billion to services but the reforms are likely to bring the total of 35 billion”. Such schemes have meant that NHS staff have been forced to work longer hours and pay more contributions for less pension. Other pay allowances have been cut or abolished and there are now harsher rules for annual leave and sickness. According to one source, around 75% of staff are working extra hours unpaid. This has meant that working conditions have deteriorated and more staff are subsequently suffering from work-related stress, bullying and harassment. Job losses are becoming a big problem. The Royal College of Nurses has just issued a report claiming that the NHS workforce has been decreased by nearly 21,000 since the Coalition was formed. This has had a direct impact on patient care. Dr Alex Scott- Samuel describes the way that rationing of services is “creating a postcode lottery and delays in essential surgical operations”.
Such a change to working conditions has come hand in hand with an increase in competition between hospitals and practices. Advocates of the Health and Social Care Bill were adamant that an increase of competition in the NHS would always be a good thing. However, many NHS staff seems to feel that the current level of competition is yet another obstruction to providing good quality patient care. Mary Taylor states that competition, coupled with a fear of jobs losses, has meant that while “we used to talk about how we could improve a service in another trust by working together, now we just want to take work off each other”. This has also meant that staff are “less inclined to stick their head above the parapet now too, as they hear of job losses in the hundreds at Circle and reduced provision and hours under Serco and Virgin”.
Given these issues that have arisen as a subsequent to the Health and Social Care Act, it is makes sense that many professionals within the NHS are feeling negative. Julie Hotchkiss, a consultant in public health in a Primary Care Trust, describes the effects of the act as “truly devastating” and “causing absolute chaos”. According to Dr Alex Scott-Samuel, reactions to these effects have been almost “uniformly and universally negative”. Another health insider has stated that the overall “the NHS is weaker” and that “few managers (amongst colleagues) disguise their contempt for the mechanisms the reforms are using”. As such, it would seem that the formation of the NHA party, as well as other activism by groups such as 38 Degrees, is a welcome move for change. Such campaigns appear set to generate support from the increasing numbers fed up with the Coalition’s approach and aren’t willing to sit back and let the new changes go unchallenged. It seems that new Health secretary, Jeremy Hunt, could have a fight on his hands.