Kate Griffin of the Oxford & District branch represented the NUJ at a May meeting organised by the Medical Journalists’ Association in London. This is her (somewhat belated) write-up of the event.
Who’s in charge of the changed NHS? That was the question being addressed by the speakers at the Medical Journalists’ Association event in May. The Health & Social Care Act became law at the start of April, but it will be some time before all the ramifications become clear.
Nicholas Timmins, King’s Fund consultant, said that the NHS has a change management programme “so large you can actually see it from space”. Although Andrew Lansley’s agenda might have seemed obscure to some, he actually laid out his intentions quite clearly in a 2005 speech. (I think Timmins was referring to the speech entitled The Future of Health and Public Service Regulation, which is still available online.) Essentially, he was trying to introduce a market element into our health service, which is very similar to what Labour were doing. Lansley was less interested in what he calls the “wiring” – the structure – and more interested in the principle of pro-competitive reform.
Timmins ended by asking: “Where does power now lie? God only knows.”
Bonnie Green, patient advocate, spoke next. She is former chair of the Richmond LINk. (LINks have been abolished by the Act and replaced with Healthwatch teams.) She pointed out that there’s more patient engagement built into the new NHS structure than you might think; NHS England (formerly the NHS Commissioning Board) has a dedicated Patient and Information Directorate, and clinical commissioning groups (CCGs) have a lay Board member for patient involvement. But it’s too early to say whether the principle of “No decision about me, without me” is really working for patients in the new NHS.
Jon Sacker, communications lead for NHS Clinical Commissioners, had a different take on privatisation. “We have a fixed envelope. Privatisation is another way of talking about rationing.” He mentioned the new Commissioning Support Units, which do what the name suggests: support CCGs in their commissioning functions. (The CCGs still have legal accountability.) But it’s useful for journalists to know about these units because they’re almost like a PR agency working for the CCG, responding to Freedom of Information requests and supplying (or not supplying) data.
Lindsay M Davies, epidemiology professor at Nottingham University, brought out the public health aspects of the Health & Social Care Act. Local authorities have new responsibilities for the health of their populations, but it’s not entirely clear who is responsible in an outbreak or disaster.
She reminded us of the often-forgotten point that the UK has a devolved healthcare system, and the Health & Social Care Act only affects England. As a result, Public Health England and Public Health Wales are very different.
She also sounded a note of caution about the way public health officials are being pushed towards jobs in the civil service or local authorities. “Where is the independent voice?”
The final speaker was Roger Taylor of the website Dr Foster, which provides comparative information on health and social care services. He is also the author of God Bless the NHS.
He said that there is a gap between “what most people want and what the policy people want”, because patients tend to be conservative. “The money has run out and the willingness to change is not there, so we can expect cracks to appear in the next 12 months.”
Looking at patient-reported outcomes yields some unpleasant surprises: some patients actually self-report as better before an operation than afterwards!
He said that if markets within the NHS truly deliver a better, more cost-efficient service, that’s great. But we’re missing out on the data to make comparisons and draw our own conclusions because private suppliers of healthcare services are hiding behind commercial confidentiality. And that won’t wash, because we need to formulate future policy based on proper evidence.
He ended with a plea to listen more to patients; currently there’s a culture of not trusting patients to know what is best, of ignoring what they say, and that has to stop.
Paul Bradshaw of the Help Me Investigate blogs was chairing the event, and took many questions after summing up. Questions raised but not fully answered included “How do working people engage with patient advocacy groups when they meet during work hours?” and “Why do we have such a complex system in such a comparatively small country?”