Wednesday, 18 April 2012

What the Health and Social Care Bill will mean for East Lancashire

It is difficult for local people to understand the top down restructure of the NHS the Government are imposing. For most people the reorganisation goes against the high profile poster promise at the last General Election when Prime Minister David Cameron proclaimed; ‘Trust me on the NHS’ and ‘No more top down reorganisations’. The Bill was forced the Commons last month and the NHS will soon see the effects.

However, the NHS reforms will be at best pointless to Lancashire - with its one hospitals trust - and at worse highly destructive as it breaks up any combined health care planning.

As with much of this Government’s policies, they are designed with London in mind, with little if any consideration of areas such as East Lancashire. Essentially, the reforms are intended to allow choice, which exists in London because of the high numbers of GP’s clinics and Hospital within a small area. This is simply not the case in areas such as Lancashire.

The NHS restructuring will see groups of GPs joining together to form Clinical Commissioning Groups (CCGs). These groups will be given a budget by the Government and will decide from within this budget which healthcare providers they will pay to treat their patients.

This will mean giving GPs responsibility for deciding which healthcare providers –e.g. hospital trusts – to send their patients.

I and the rest of the Labour Party had a huge number of serious objections to these reforms nationally. The Bill unfortunately passed, despite our efforts to defeat the Bill.

Nonetheless, my criticism of these reforms from a local perspective should still be addressed as many local issues exist. This won't bring choice, it will end health care planning such as new health centres; it may allow GP's to operate under the radar of scrutiny; it leaves a confused estate of buildings that may lead to rationalisation - closure of smaller hospitals unable to meet health care market demands; it may well bring extra bureacracy or gaps in service.

East Lancashire Hospitals Trust is the trust that manages the main hospitals in East Lancashire: Royal Blackburn Hospital, Burnley General Hospital and Pendle Community Hospital. The Trust also provides services for The Accrington Victoria Hospital, Clitheroe Community Centre, Blackburn Birthing Centre and Rossendale Primary Care Centre.

Once the new East Lancashire Clinical Commissioning Group is up and running, the vast majority of patients will continue being sent to one of these local hospitals. This will be from logistical practicality alone, to say nothing of relationships developed between CCGs and local Trusts.

The government’s argument that this will introduce choice is facile and totally misrepresents the situation.

The Government’s only intelligible and tangible reason for the reforms is that giving GPs power and forcing providers to compete with each other for contracts will drive up standards.

Clearly if the vast majority of treatments will be, as always, provided by the nearby Trust hospitals, then any potential benefits of competition will be immaterial.

However, despite these natural links that develop between GPs and their local hospitals – where they will clearly want to send most of their patients - and where patients will want to go – GPs may be subject to EU competition laws. If they are seen as having favourable relations with a local, trusted hospital trust, there is a concern that they may face penalties for anti-competitive behaviour.

It is difficult if not impossible, then, to see the benefit to people of East Lancashire. GPs have little alternatives to the local Trust to send their patients. Patients do not want travel further for treatment and for many poorer people in East Lancashire, travelling further is not an option. It is ridiculous to think that GPs should look around the country for hospitals to send their patients when there is a perfectly good local hospital with which the patients are familiar. To say that standards will be driven up by introducing choice and markets is therefore simply misleading.

If we are as optimistic and trusting as possible about the Government’s claims of the benefits of competition, we can see that at best the plans do not benefit East Lancashire and other regions where most local hospital services are run by the local trust.

There are no benefits to the reforms for areas such as ours where there simply isn’t a wide variety of hospital service providers. This lack of options is not a weakness of the current system – it is inefficient to suggest that we should replace our excellent local hospitals with more, spread-out and less integrated service providers. We should concentrate instead on improving the existing hospitals.

Furthermore, the argument for competition threatens predatory clinical provision by greedy private sector providers who cream off profitable, easy services and leave Hospitals such as Royal Blackburn to carry all the cost of less profitable services that must be provided.

Of course, we have already seen in West Yorkshire that some of these less profitable services do not need to be provided. GPs have sent letters out informing patients that GPs will provide certain medical treatments privately only – clearly a conflict of interest when they are the fund holders of NHS budgets and patient budgets.

The Government have pushed through the reforms with the competition argument that has only London in mind. Only in London and some other cities there are more providers packed into the city so there are more procurement options for GPs.

Primary Care budgets and the PCTS themselves have been abolished leaving two fundamental problems? Who will manage their buildings and will they be managed for profit eg the seven new East Lancashire health centres. Their ending also ends the three proposed new heath care buildings and I intend to write to Andrew Lansley to ask if this is his vision of on a new NHS? Secondly it puts the budget for health care prevention in the hands of unqualified GP's. It's one thing to say 30 minutes of physical activity saves the NHS £millions. it is another to ask a group of people who have no experience of delivering such a programme to begin understanding and spending such a budget.

It reverses the logic of the last Government and the former Tory led Blackburn Council which merged the PCT and The Council and offered free recreation at all it's facilities part funded by the PCT through the Bee Card. Do GP's have this experience and nous? This NHS Bill is clearly a huge backward step for East Lancashire in primary care.

Yet again the Government is making decisions with no regard to rural areas and regional issues. The only possible tenuous argument they have given for the reforms will not benefit Lancashire. We are only left with the downsides. And there are many.