Whatever the government says today in response to the Future Forum, the sad truth is that the NHS is unsustainable in its current form. But no political party will do what needs to be done for fear of the electorate’s reaction.
The government will today announce its response to the review by the NHS Future Forum into the controversial Health and Social Care Bill. After a pause to ‘listen and learn’ we will know what remains from the original proposals.
It might be useful to examine in more detail the two most controversial themes in the legislation: commissioning and competition.
The government’s original plans were for GPs to be the focus for commissioning decisions, but clearly there has been a strong fight back from hospital-based doctors and nurses who see major dilutions of their level of influence and power over what hospitals actually do.
The Future Forum report states there should be a strong role for clinical and professional networks, with multi-speciality ‘clinical senates’ providing advice to commission consortia. This seems likely to clip the wings of those GP consortia more ambitious to make changes in the delivery of health services.
In terms of competition, the reality is that NHS trusts already compete with one another but only on access – quality but not on price. One possible approach might have involved having price competition between NHS trusts and between NHS Trusts and the private sector.
This could have been political dynamite if the private sector won lots of contracts and funding (which they might have with effective pricing strategies) and could have opened the government to the charge of privatisation by the back door. In the event, the Future Forum report gives a thumbs down to more competition and scales back several of the proposals in this area.
Whatever the government’s response, and it likely to agree with most of the Future Forum’s recommendations, much of this is ‘fiddling while Rome burns’. Growth in NHS funding is effectively zero while demand for health services increases at 4%-5% each year. There are several factors at play here:
- The difficulty of effecting changes in the NHS because of public opposition to change fuelled by health professionals, opposition politicians and the media.
- High levels of restrictive practices among health professionals, which no government has the courage to address
- High levels of self-inflicted morbidity caused by lifestyle factors
- NHS funding growth is stalled but demand continues to increase. The current tax-based funding method is probably unsustainable but nobody will admit this
The sad truth is that the NHS is unsustainable in its current form, but no political party will do what needs to be done for fear of the electorate’s response.
