I was in Westminster on Wednesday 12 th October the day of the Lords vote on the Health and Social Care Bill. The atmosphere was tense but the Bill passed with a reasonable majority. Controversy has been connected with the Bill from the start. This is frustrating as it was developed in response to what knowledgeable people involved in healthcare asked for. This was better access and choice for patients, service redesign steered by clinicians and a reduction in management. It seems that competition and private providers raised more antibodies than predicted.
The debate became polarised in the media leading to trade unions warning of an “American style health service” words designed to frighten the public in the same way that an “NHS style health service” frightens Americans .With powerful professional organisations speaking out against the Bill it has been difficult for the Government .They have at times failed to articulate the policies in an effective manner.
One issue with promoting the Bill has been the language used to convey the message rather than the actual message. Most GPs would support the concept of reviewing services and redesigning them to make them more effective. Most patients would welcome a choice of provider and the better quality and access that would result from competition. Most patients do not care who provides a service as long as it is free and of good quality. These are key goals of the reforms. The emphasis following the “pause” has shifted from competition to integration and this is probably a good thing. However the two are not mutually exclusive. For instance within a chronic disease management service it should be possible to secure a contract to provide the whole service via a competitive procurement process and then sub contract aspects of the service which could be provided by a number of competing providers via AQP
Private v NHS provider, Competition v integration, clinician led cost control v management led cost control . The arguments are complex and reactions have frequently been emotive. Few seem to have challenged the sacred cows or considered why certain views are held, The debate has generated much heat and little light.
The BMA and RCGP have rightly proposed changes to the Bill and the Government have listened and sensibly altered the wording of the legislation. I wonder if these bodies are always representative of grassroots GPs? Similarly when they have been positive about the reforms this has not been widely reported. The effect is a negative pervading attitude to the reforms. Negative health care professionals have lead to a negative public who are often bamboozled by the debate and just want an appointment with their family GP or to be able to park at the Hospital.
The detractors of the reforms have realised that they can effectively influence the Government and they are unlikely to give up, this presents a challenge to the Government. There will be a tipping point where the changes proposed by the detractors will be receive less support and the reform supporters will be in the ascendancy. The point at which this will occur is difficult to predict.
The Bill is nevertheless is likely to pass into law without further significant change. The NHS has already been set on a new path. It is absolutely essential that the changes continue to be implemented. Failure to do so will result in real problems with the NHS
To ensure implementation this Government must take the rump of the medical profession with them in particular GPs. What motivates clinicians to change is
- Providing better services for patients
- Seeing others providing better services for patients
- Making financial gain from developing services and providing them.
- Being able to make changes easily and quickly
What de-motivates clinicians is
- Compelling them to do something
- Imposing decisions from above without logical explanation
- Excessive and confounding bureaucracy resulting in no change
The bill provides all four key motivators. Clinicians who are not the “usual suspects” need to be encouraged to see the potential of the changes and speak about them in the media. Examples of good progress and results need to be shared and celebrated more effectively and often. It is very important in the developing guidance that the de-motivators do not become obstacles.
Quite simply the reforms cannot fail and it is time our professional bodies were encouraging. The more clinicians that embrace the reforms the greater the chance of success and ultimately the better the NHS will be.
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