The Conservative Secretary of State for Health Andrew Lansley announced his plans to reform the NHS in June last year with the publication of the white paper Equality and Excellence: Liberating the NHS.
The changes came as a shock to many having not been set out in the Conservative Party election manifesto or the Coalition Agreement. Some have called foul, claiming the programme for reform tabled in the Health and Social Care Bill has no mandate.
In his 2006 Conservative Party conference speech, David Cameron claimed he could spell out his priority “in three letters: NHS”. Journalist and political commentator Joy Johnson believes this is a brutal attack on social welfare. Writing in the magazine Tribune she said the reforms would mean healthcare provision “calculated, not on quality, but on cost”.
This echoes a belief that the reforms have been sprung on the country and are being rushed through Parliament. The Government’s plans have stirred up mutinous rumblings among doctors and the Coalition. The discontent was evident at the Trades Union Congress’ (TUC) March for the Alternative anti-cuts protest of 26 March 2011.
As members of the public sector union Unison, the UK’s largest trade union, streamed through central London to Hyde Park it was clear they were upset. The fired-up mood and rousing speeches aside (with the exception of Ed Milliband’s effort), it was clear that the ire and indignation did not have a universal focus among the marchers.
Opinions of marchers at the TUC March for the Alternative: Andrew White, Royal College of Nurses Convener at Barts and the London NHS Trust; Dominic Walsh, Ward Manager Whittington NHS Trust; Hamish Kemp, Community Learning Disability Manager, Manchester NHS Trust. Vox pop question: What do you think is the motivation behind the NHS reforms?
However a physician, who wished to remain nameless, commented that the UK is in the middle of a transition; a fundamental change in the social contract that underpins the heart of the NHS. While treatment to all when required remains the goal, he said, we no longer want a blanket provision of healthcare but the ability to choose our provider and services. This has been advancing for the last two decades or more, he added.
The NHS reform white paper sets out plans to add “autonomy, accountability and democratic legitimacy” to the health service through GP commissioning. Although it may fly in the face of the Left, it could be less that Mr Lansley is a forcing his ideology on an unwilling populous and more he is in step with the social and political zeitgeist.
The white paper does emphasise freedom of choice and transparency; it could be leading the NHS into its future. No longer would there be a hierarchy of the medical profession and hospital administrators over the patient.
So is this is an ideological reform born out of 30 years of neo-conservative rule? The Department of Health has refused to comment. Dr Katherine Adams, a GP working in London, is under no illusions that the reforms are driven by ideology, saying: “Conservatives don’t like the state having a big role in society.”
Dr Adams does believe there is room for improvement within the NHS, particularly on patient voice. However, she challenges the perception that root-and-branch reforms are the way to fix this.
Dr Sarah Wollaston, MP for Totnes and member of the health select committee believes reform of the health service is necessary. Writing in the Guardian: “Despite throwing cash at the NHS [over the last ten years], productivity was flat or declining…The proposed reforms are a serious attempt to address commissioning problems and improve care for patients.”
Soon to matriculate medical student Luke Render has always assumed the NHS will be his future employer. He will begin his course next year at King’s College London knowing his time in training will run parallel to efficiency savings and restructuring. What shape his future employer will have remains something of a mystery. Mr Render believes it will all come to naught: “I honestly don’t think the reforms will stand up. By the time I’m practicing it will have returned to how it was.”
There remains a great many unknowns about these reforms however; including the obfuscating presence of Care UK’s campaign donation although presumably above-board. In questions from the health select committee hearing of 22 March this year it was clear that committee members were concerned about the rate at which these reforms have been brought before Parliament. It is the uncertainty that the pace of reform has engendered, says Dr Adams, that is alarming both NHS workers and public alike.
Images taken by Jack Serle, all rights reserved
Transcript of marchers’ opinions
Healthcare needs to be reformed to ensure the services that are provided are properly sorted out. But again I don’t think there has been much thought into how nursing and how the public wants these reforms to actually happen. They’re trying to do it too quick, too fast; it’s not actually been thought through. It needs to change and it needs to slow down.
My personal opinion is that it’s an ideological change based on Conservative values of free competition.
£21,000 from UK Care. Can you elaborate? That’s what he received from UK Care prior to the General Election as a donation.
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