open up and say aaaahhh
For once I’m quite nonchalant and sanguine about something that the coalition is up to. I just can’t seem to get worked up about the proposed NHS reforms and really don’t see any need to panic. It strikes me that the basic principles – a universal system, free at the point of use and funded by general taxation – isn’t being changed and all they’re doing is fiddling around with the supply & demand mechanism of the services provided.
For the last 25 years, the NHS has been essentially divided into two halves, the buyers and sellers. The latter are the hospitals and the former (who operate as the buyer for GPs) are the primary care trusts and direct hospital trusts. Health secretary, Andrew Lansley’s intention is to abolish the PCTs and hospital trusts and allow the GPs to hold the budgets themselves and buy directly from the providers. Big deal.
My only two areas of concern are that GPs and doctors already have enough on their plate and should we really be asking more of them in respect of administration and management, which invariably will involve large amounts of red tape and bureaucracy? Surely it makes more sense that we allow them more time and freedom to do what they’ve been trained for? The second one concerns the proposed expenditure for future years. Its £104bn budget is essentially being frozen for the next four years (ok, 0.4% growth if you want to be pedantic) but taking into account the increasing levels of costs and inflation this is actually going to represent a major cut in real terms. If the NHS is going to continue with developing and improving services for, let’s say, the elderly, the mentally ill and cancer sufferers, it has to find £20bn of efficiency savings by 2014, whilst, at the same time, increasing its productivity by 5% a year, something it has never achieved in the past. It ain’t ever even got close.
In the longer term the big question which has to be addressed is how we continue to fund the services and health provision. Our spending on the NHS has doubled each decade since 1980, from 3% of GDP to its current level of 12% but given an ageing population (and all that goes with that) and higher expectations of what can and should be provided, we need to look far more closely at how it is funded and to what level. Couple this to rising costs, a potential world recession and falling tax revenues, radical change is perhaps inevitable.
