Below the views of Britain's most consistently accurate health policy
commentators (google their publications over the last 20 years if you
require confirmation) are quoted from a BMJ article
(Extract)
BMJ, 341, 228-231
White paper
More brickbats than bouquets?
We asked a range of commentators from clinicians to academics to comment
on the white paper on health/ Equity and excellence: liberating the NHS.
/Has the NHS become "a huge laboratory for some dodgy experiments," in
the words of one commentator; will the white paper divide the medical
profession, as another claims; or will it simply empower doctors?
David J Hunter, professor of health policy and management, Durham University
The changes to the English NHS leave no part untouched. Once again, it
has become a huge laboratory for some dodgy experiments. A few good
things are in prospect, including the move of public health to local
government and an expanded role for NICE (National Institute for Health
and Clinical Excellence). But these stand to be eclipsed by other hasty
and ill conceived proposals.
Handing responsibility for commissioning to 500 or so GP consortiums is
high risk. There is no evidence that a reckless shift of power and
resources on this scale will succeed. The evidence from the past 14 NHS
"redisorganisations" suggest otherwise. Like GP fundholding in the early
1990s, GP commissioning may prove to be more of a wild card than a
winning hand. To claim the changes are about culture and not structure
is disingenuous and flies in the face of what is happening as primary
care trusts wind down.
Putting patients at the heart of everything may improve care for some,
but probably not for all with the "inverse care law" becoming more
entrenched. The principal beneficiaries of the changes, apart from some
enthusiastic GPs, will be private healthcare companies already circling
and ready to swoop to make a killing from the NHSs ringfenced budget
and, in the process, fragmenting services, "gaming" the system to cherry
pick patients, and driving up transaction costs.
If our politicians cannot be trusted as stewards of the NHSresorting to
the default position of massive structural upheaval despite all the
evidence testifying to its dysfunctional impactthen those "overpaid"
managers advising them should know better. But, nurtured under New
Labour with its multiple NHS restructurings and move to markets and
competition (which have paved the way for the latest proposals), the
managers are mere "change junkies," relishing a new governments
cherished schemes regardless of the irretrievable damage they will wreak.
Allyson Pollock, /professor of international public health policy,
Edinburgh University/
The NHS in England is to be dismantled and instead health care will be
run on US healthcare lines. If this paper is enacted then for the first
time in 60 years the citizens of England will experience a return to
fear. The hallmark of our health service is public funding raised
through general taxation; public ownership, and public accountability
for services; and area based planning and allocation of resources for
services delivered on the basis of need and not ability to pay. But
unlike Scotland and Wales, which have reversed market oriented changes,
successive English governments have eroded the foundations of the NHS in
England, paving the way for market and profit oriented health care to
introduce private "for profit" elements into clinical care.
And now, with neither an electoral nor a moral mandate, the legal duty
of the secretary of state to provide universal care to the whole
population on the basis of need and not ability to pay is to be
abolished. The NHS will be reduced to simply being the government payer
and patients and staff exposed to the full weight of market forces. NHS
providers will be given greater freedoms to raise income by selling
health care through patient charges and reducing access and entitlements
to NHS care. Planning controls through public delivery and the
structures and mechanisms that protected universal healthcare fairness
and equal access for equal need will be displaced by the market. GPs do
not have professional training or experience in health service planning
let alone commissioning; meanwhile the private for profit sector and
multinational healthcare companies are lining up to take control of the
£80bn ({euro}95bn; $123bn) of NHS resources. The BMA and all doctors
have a duty of care to patients, they must not let the NHS go
undefendedand neither should the citizens of England.
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