Sunday, March 20, 2011

GP criticises Tory plans for NHS. She's also a Tory MP.

Writing in the Telegraph, Dr Sarah Wollaston makes some trenchant criticism of the NHS restructure - a policy that she did not campaign for as part of the Tory manifesto and one that did not form part of the coalition agreement. Indeed, Andrew Lansley promised in opposition an end to top down reforms of the NHS. In government, he's delivered nothing but that.
And if that wasn't enough, NHS quality monitors remind their management colleagues that

I wonder if Lansley or Cameron will quote those next time or if they will keep trotting out their misquoted claims of support from John Healey, the Labour health spokesman (who has now written to the PM at least twice asking for an apology for the persistent misquotation). Funny thing is, Cameron never bothers quoting from the rest of the speech, which certainly isn't supportive of the direction of travel.
these are the wrong reforms at the wrong time, “blunting the ability of the NHS to respond to the Nicholson challenge” to improve services to patients and make sound efficiencies on a scale the NHS has never achieved before

modernisation plans will leave few parts of the current system untouched and past experience and lessons from elsewhere shows that any period of structural change can put quality and safety at risk

It is one thing to rapidly dismantle the entire middle layer of NHS management but it is completely unrealistic to assume that this vast organisation can be managed by a commissioning board in London with nothing in between it and several hundred inexperienced commissioning consortia. In reality the reforms manage to be both 'top-down' and 'bottom up' but we could end up with the worst of both worlds. Stripping out primary care trusts (PCTs) and strategic health authorities is as top down as it comes....

...without some experienced guidance and continuity, the consortia are doomed to fail and will have to hand over their commissioning to the private sector. An organisation responsible for over £100billion needs people who seriously understand accountancy and, trust me, GPs do not.

Bearing in mind that the NHS Commissioning Board in London will be responsible for commissioning every GP practice, pharmacy and dental surgery, it is clear that they will need some regional presence. I cannot see that it makes sense to foot the bill for redundancies for the entire middle layer of NHS management only to be re-employing many of them within a couple of years. Commissioning consortia will be overwhelmed trying to adapt to their new roles. Someone needs to get a grip or we will continue to haemorrhage the best staff as a result of intolerable uncertainty and pointless morale-sapping denigration. It all risks going 'belly up' rather than 'bottom up'

No comments: