UK coalition health plans in a nutshell [with commentary]

Scrapping primary care trusts (PCTs) [neutral-to-good], replacing them with GP commissioning consortia to make local health services more responsive to local needs [sounds good but a minefield of conflicting interests for GPs; making services locally responsive does not make them regionally or nationally equitable].

Removing regulatory powers of NICE so that consortia make decisions to fund treatments on a local basis [=removal of main justification for NICE’s existence and return to postcode lotteries, so bad].

Moving public health function into local authorities [good in principle- if allows health considerations to more effectively influence housing, transport, and environment policy, but bad if leaves the public health profession distanced from NHS with limited influence over consortia].

Scrapping the Health Protection Agency (HPA) quango, and absorbing its functions into a new Public Health Service directly answerable to the Department of Health [pointless politics, bad if only because expensive and disruptive- does the Health Minister really want or need a role in containing pandemics?]

[So some good in there, some that’s worrying, and a lot we don’t know. The white paper, ‘Liberating the NHS’, has the tagline equity and excellence, and it makes some of the right noises: putting patients at the centre of decision making; empowering health professionals; devolving decisions to local level and making services more responsive; focusing on clinical outcomes rather than process outcomes (eg strokes averted rather than annual medication reviews completed).

But I feel sorry for the proposed new national NHS Commissioning Board, tasked with overseeing the local commissioning processes and making sure health inequalities are reduced. They will have a difficult job, given that the proposed changes will, at best, be neutral with regards to this worthy aim— and may even work against it.

At a personal level, these changes just provoke the usual sinking feeling of frustration towards politicians. The current UK (or more accurately now, English) health structures are far from perfect, but they work ok most of the time. Do we really need expensive and disruptive changes yet again— and at a time when there’s an economy to fix? Please, politicians: STOP FIDDLING!]


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