The Health and Social Care Act 2012

One of the coalition’s flagship policies is their widespread reform of the National Health Service as legislated through their Health and Social Care Act which passed earlier this year. While the previous Labour government did achieve some improvements on the NHS, giving it more resources, dramatically cutting waiting lists, and improving quality of care in many areas. However they still left much to be improved upon with high inefficiency as well as lagging behind Europe in several areas. The Coalition’s reforms were set to improve this by reforming the system entirely, however while they do have some advantages overall they will not improve the delivery of healthcare for all in a significant way.

One way in which the Coalition claims that the Health and Social Care Act will improve the delivery of healthcare for all is that it will cut down much of Labour’s needless bureaucracy, allowing GP’s to focus their care on patients and streamline funds to where it is needed. To this end the Bill plans to abolish the old PCT’s (Primary Care Trusts) and instead replace them with smaller groups of local GPs and other clinical specialists called “Clinical Commissioning Groups” (CCG) who will be responsible for using resources to secure services from providers for their patients. This will give GP’s an extra level of control over how they allocate their resources, allowing them to focus on the particular needs of the patient and freedom to pursue what they see as best from a professional perspective. This will improve the delivery of health care as patients will be able to get the treatments their doctors think they need without having to go through a needless bureaucracy, essentially focusing the delivery of healthcare on the needs of the patient according to the profession opinion of the doctors.

However while the idea of patient-centred care from doctors is certainly behind the NHS reforms, the Act itself actually limits this from happening and dampens the effectiveness of CCGs. The Bill also adds another level of bureaucracy over CCGs called the NHS Commissioning Board (NCB) which the government claims is merely there to advise CCGs, and to guide them in ensuring improved quality, equality and patient choice. However several conservatively minded groups supportive of the release from bureaucracy that CCGs initially promised, such as the NHS Alliance, have claimed that in the final version of the Bill the NCB goes far beyond the initial idea of helping guide CCGs and instead turns into another complex layer of bureaucracy, management and guidelines which threaten to stifle the supposed freedoms granted to CCGs. They point to the fact that much of the bureaucracy of Labour’s old PCTs and SHAs (Strategic Health Authorities) is not being eliminated, but is instead simply being transferred, becoming the new local offices of the NCB. Also the final version of the Bill states that the NCB to ensure the “achievement of health outcomes” widely interpreted as giving the board the ability to interfere in CCGs in order to achieve desired targets and outcomes. Both of these completely counter the point of giving freedom to CCGs to provide patient cantered care and rather than improving the delivery of healthcare for all simply promise to further stifle improvements with needlessly complicated legislation and bureaucracy.

Another perspective on CCGs which has been voiced by doctors and the Labour opposition, that has brought criticism of the Health and Social Care Act is that GPs are not ready or able to handle the money being given to them to spend as part of the CCG system. Many GP organisations have expressed concerns that to manage the entire budget themselves would not lead to improvements in service but would actually lead to further problems. Rather than having resources allocated from larger regional bodies GPs will have to be able to provide for all their patients from a limited local fund, which may cause some patients to lose out as GPs find they cannot afford to provide the best quality care for all of their patients. Small CCGs may only be able to afford to focus on certain treatments commonly needed in the local area which could see patients with more complex and rarer diseases forced to wait as their expensive treatments would eat an unaffordable hole in the CCG budget. The CCGs will simply lead more local variations in NHS care and worsen the delivery of healthcare overall. The government has claimed that the rationing of treatments will not be acceptable, but no alternative is offered so many fear that this will be the reality.

The second major way in which the Coalition government claims that the delivery of healthcare will be improved through the Health and Social Care Bill is with the pioneering policy of allowing CCGs to utilise “Any Qualified Provider” whether they are in the public or the private sector. This means that for certain conditions GPs will have the ability to choose private sector companies to provide services for their patients if they perceive that it will result in a higher quality of care. This will improve the delivery of healthcare in two ways; firstly it will allow NHS patients access to higher quality care if it can be found in the private sector, an innovative concept which could help in cases of rare illnesses. Secondly it will increase marketisation and competitiveness within the NHS. Not only will NHS providers have to compete with each other to provide for CCGs, they will now have to complete with the private sector as well. This will raise standards by forcing NHS providers to meet the high quality of their private counterparts as well as increase efficiency as providers strive to operate a more streamlined service in order to complete. This will also provide for a greater amount of choice for the GP and patient, allowing them to get the best treatment the patient needs rather than simply being saddled with below standard healthcare because there is no alternative that is free at the point of delivery.

However this move to allow private companies to provide NHS services has been the cause of fierce criticism from many organisations both medical and the Labour opposition, who support the traditionalist Labour belief in the superiority of a public health service over private providers. Many claim that this is the first step in an all-out privatisation of the NHS, as NHS providers are gradually replaced by their private counterparts who can afford to provide cheaper care. In time this could undermine the entire principle of the NHS system, as private companies replace public providers. Another issue here is the fact that private companies are often motivated solely by the desire to make profit, they seek to sell their services at the highest possible price with the lowest possible cost. This will mean that while GPs may be attracted to private companies because they are cheaper the actual quality of care will decrease, as it has been produced at the lowest possible cost. NHS providers on the other hand, while sometimes inefficient, at least have the need for higher quality healthcare as their central ethos as opposed to profiteering. Overall the increased involvement of private companies can only damage the NHS; because they can provide cheaper services they could negatively impact current NHS providers who could be forced out of business, and their quality of care will inevitably be faultier as private companies seek to produce with the lowest possible cost.

The Coalition Government’s Health and Social Care Act will  not overall improve the delivery of healthcare. Many GP’s have criticised the plans to reform the PCTs into CCGs, claiming that it will put undue financial pressure on GPs. And even those organisations, such as the NHS Alliance, which support the freedom of GPs to decide which services to provide state that the claimed elimination of bureaucracy does nothing more than give the same organisations different names. While the government claims that utilising private companies introduces further competitiveness and choice, it also undermines the very principles of the NHS as adds the profit motive into a sector that should remain motivated by the desire to give free and good quality healthcare for all.

Nicholas Ttofis

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