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On a hiding to nothing


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Friday, 13 January 2012

On a hiding to nothing

Sympathies to all in the DH press office who must be reflecting ruefully on what curious twists of fate and career turns led them to their present jobs. Instead of defending the reforms, they might have been doing something easy - working for an industrial giant explaining a fatal chemical spill or an airline explaining the loss of a 767 over a built-up area.

There’s no good news story to be mined from the RCGP survey which claims to show all but about three of the nation’s GPs are against the reforms. Even if it’s a big number out of a small number – the survey was completed by only about 6% of RCGP members – 98% of the sample still gave the health and social care bill the thumbs down. 

A hospital registrar writing in the Guardian gives his reasons for ditching the reforms. He tells a story about a meeting of GPs who were asked "Please raise your hands if any one of you does not have serious and grave concerns about the health and social care bill." No hands went up, of course. But exactly the same result would have been forthcoming if the question had been: “Please raise your hands if any one of you does not have serious and grave concerns about the sustainability of the current system” or “Please raise your hands if you don’t think the NHS is in need of improvement.” 

The author raises the 80% satisfaction rating patients give to the NHS as a reason for leaving well alone. It is not clear why one in five unhappy patients is a source of pride.

All GPs think commissioning should be clinically led and that they should have more say in local services. But when you add the corollary that things have to change to make these things happen, enthusiasm wanes fast. 

The stock objections are “right idea, wrong reforms” or “they’re selling off our NHS” all backed by the unchallengable assertion that patients will suffer. The suspicion that, as the article’s author puts it “this monstrous bill is designed to privatise the NHS at every level” is nothing more than that, a suspicion borne out of prejudice. The policy detail has nothing in it to support this view. It looks like an attempt to create competition in the interests of greater choice for patients and value for money for the NHS. And the other intended beneficiaries are not American owned consultancies but the social enterprises and community providers who might not otherwise get a look in.

The wholesale privatisation of the NHS is simply one of those monsters people find it easy to believe in with or without the help of evidence. It’s a lose/lose for the government which is depicted as either privatising by stealth or by accident, dishonest or reckless. 

It is true that the relationship between patients and doctors may be challenged and with it the doctor’s place at the top of the annual “most trusted” survey run by the BMA.

That’s because it will be harder for doctors to point the finger of blame at the PCT when a local scandal breaks about postcode lotteries for cancer drugs. Leading and influencing come with drawbacks. Giving up the unconditional love of patients in every situation may be one of them.

Professor Steve Field is also in The Guardian this week. The chairman of the Future Forum, the only person feeling less isolated and unloved than a DH press officer, points out that the unwarranted variation in care will not be solved by throwing money at the problem and that we have gone too far to turn back. These are serious issues that won’t go away if GPs withdraw their support. 

Professor Field also criticises clinical leaders who “get up in the press and just carry on saying the NHS has to stay as it is”.

Several commentators are saying we could have the good things in the reforms without the reforms themselves. Perhaps, but we didn’t and we haven’t and it’s funny that they’re only saying that now.

Bumpa says:
Jan 13, 2012 02:56 PM
As a lay member of various PCT groups over the years - including Clinical Commissioning Group (used to be PEC)the biggest challenge of old was to get clinicians to motivate themselves to get involved. The opportunity was there - what has changed?
griffine@amgen.com says:
Jan 13, 2012 04:51 PM
I don't work directly for the NHS but I can't help but feel that another article braided throughout with negativity does no good for anyone or anything. It wouldn't ber stood for in other organisations.
jpatterson says:
Jan 13, 2012 05:48 PM
Edward, I couldn't agree more. We should not stand for negativity including spurious and disingenuous arguments against progress. I also accept that we probably should not stand for me either.
s.cribb@nhs.net says:
Jan 16, 2012 12:27 PM
Not sure if we are reading different articles... the one I have just read sounds broadly supportive of the "need" for change and questions the validity of the RCGP claims for support for rejection of change i.e. by only say 6% of GP's.
andrew.riley@northstaffs.nhs.uk says:
Jan 19, 2012 10:02 AM
And now the nurses withdraw their support and are told that they are 'putting their jobs and pensions before patients'.
What do pharmacists think?
Given that our profession has been buffeted around and paid scant regard, despite providing 2.3 million daily interactions with patients (which dwarfs every other profession) and being the most innovative and adaptable profession in the past 10 years, surely we have a view about our position within the NHS infrastructure and what support GP commissioners need from us to run the NHS well?
Seemingly we dont have a view from our perch on the fence or are we too afraid or too timid to speak out? Do we have a 'voice' or do we leave it to the Company Chemists Association to speak to government on or behalf? The challenge of medicines optimisation confronts the NHS and the pharmacy profession stands ready or are we too wedded to supply and will the big vested interests ensure that it stays that way?
Soon there will be a surfeit of pharmacists as the new schools (full of overseas students) come on line and will we see pharmacy graduates swelling the numbers of young unemployed? as there wont be enough space behind the dispensary bench and shop counter.
We owe it to them to speak out and offer them a more professionally fulfilling future where there newly acquired knowledge and skill can be put to good use.. dont we?
jpatterson says:
Jan 20, 2012 10:09 AM
Andrew, I don't know if you're aware of the Healthcare Professionals Commissioning Network which was set up to make sure that pharmacists (and others) have a say. The network was an important influence on the government's decision to rebrand GP-led commissioning as clinical commissioning.
Get in touch if you want details.