This site is intended for health professionals only

Does the NHS need such dramatic reform?

Marilyn Eveleigh
Nurse Adviser and
Independent Trainer
East Sussex

The most radical NHS reorganisation of all time is to be paused so a 'listening exercise' can be undertaken. The bill is working its way through Parliament, but this is a very, very unusual step for any government to take ...

The planned 250+ GP consortia with control over 80% of the health budget and the greater use of private providers have not been universally welcomed since the announcement within months of the coalition government coming in. Initial concerns have escalated with doctors and nurses, health managers and among GPs themselves. There is now outright opposition to many elements. Labour has called for a complete scrapping of the plan.

Why has this happened? Certainly, the pace is worrying. There has been little debate and virtually no testing of such a sweeping reorganisation. Apparently, most GPs have agreed to take on the responsibility, but without clarity and experience of what the commissioning and budgeting of services will really mean. Many GP consortia will not be ready by the 2013 deadline and the listening exercise must provide some plans as to how to bring confidence and equality to all GP consortia to take on the responsibility. The British Medical Association are concerned their members may not have the skills and support for the challenge - public expectations of the profession is high and failure will damage a rosy reputation.

There are emerging concerns that GPs may have substantial conflicts of interest. As they are often shareholders in, advisers to and providers of services they may be commissioning, they could benefit personally from some of the decisions they take. As GPs are effectively private businesses commissioning decisions must be transparent and show robust accountability with public meetings and records made available. The culture of GPs' privacy will need to change - can GPs accept this?

To balance this potential conflict, the House of Commons Health Select Committee suggests hospital doctors, public health leaders, social care staff and councillors should be on the GP consortium board. And this is exactly where nurses must be. Our presence at 80% of healthcare consultations, both directly and indirectly, means we have an informed perspective on patients' needs. The government will consider having a more diverse board but decision-making must not become clumsy and sluggish because there are too many players.

The risk of private companies 'cherry picking' the services they will undertake is of real concern, especially to the public who love their NHS. The less profitable but complicated care programmes requiring longer hospital stays are generally those caring for older people and those with complex needs - the most vulnerable in our society. These are likely to be unattractive to private companies. However, where they want the business, competition law invoked by private healthcare companies could undermine local hospitals and the NHS. Mr and Mrs Joe Public need reassurance on this.

Will this 'pause' make any difference? The government has made a commitment to listen to concerns about the pace and politics of the proposed changes. Listening will not be enough. They must do more to convince the public and healthcare professions - and many of its own MPs - that there is a need for such dramatic change.

In April, nurses gave an unprecedented vote of no confidence in Mr Lansley, the Health Secretary, at the Royal College of Nursing annual conference in Liverpool. He apologised that his reform plans have not been well communicated, while reinforcing his intention to keep NHS services free and wanting help from nurses to maintain the best principles of the NHS. Nurses need a lot of convincing about the present NHS, never mind the future one.

The crux of the problem is that the reorganisation of commissioning for NHS healthcare is happening at a time when there is a reduction in funding for NHS providers of the services. The two issues are related. This reorganisation will cost £1.4bn for 20,000 redundancies (mainly managers), developing new staff and organisations.

Is reorganisation really necessary? Nurses are not convinced: they have challenged the reforms. Mr Lansley was rebuked - but said he would listen and reflect on the national nursing voice. That's a result. But as I write, the structures, elections and posts are being established in England at YOUR local GP consortium. No pause here! I suggest you find out what is happening in your patch. Hold Mr Lansley to account.