United Kingdom
George’s Bungle – No pot of gold for the NHS under this rainbow - Craig Barratt
The Government announced in its White Paper radical plans to restructure the NHS, shifting the responsibility and accountability for the purchasing of health services to groups of local General Practitioners. Regardless of whether GPs welcome this new role or have the capability to take it on, George Osborne’s approach in the Comprehensive Spending Review to the funding of the NHS over the next four years may well have made their job an impossible one.
As promised in its manifesto, the Government has committed to a notional level of real investment; with various commentators putting this figure between 0.1% and 0.4% per annum. However, this notional investment needs to be put in the context of:
- Significant historic and planned growth in demand;
- The need to ensure the clean transfer of public health income and expenditure to local government – ensuring that costs are not maintained when the income moves;
- NHS price inflation that regularly outstrips all other measures of inflation e.g. on drugs;
- A need to invest in Social Services and ensure that joint working with local government does not lead to a leaching of spending between the two public sector bodies.
The key point is not how ‘real’ the growth is, or how much extra is or is not being invested. They key point is whether ‘fan faring’ continued investment in the NHS and the protection of services has tied the hands of GPs and managers. Following the announcement of 25% cuts to local government, the public will expect services provision to reduce as well as for efficiency to improve. Few believe that such savings can be delivered by the reduction of overheads. Such an expectation has not been created regarding the NHS.
High expectations of public services, and health in particular, is a positive thing. However, when such significant change needs to be delivered in such a short space of time, a public that has been told the NHS has been protected will not expect the closure of its local hospital, a reduction in the number of nurses or longer waiting times for operations. A reduction to income, or at the least a more clear presentation of the challenges the NHS will face, would have given greater permission for GPs and managers to act. Combine this with a pay freeze for NHS staff earning over £21,000, and increased pension contributions, the radical changes required may well be extremely difficult to deliver.
In accepting this challenge, GPs and NHS managers must pro-actively involve the public at a local level, explaining clearly why change is required. They have to make “No decision about me, without me” a reality, not simply a slogan.
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