Tuesday, 13 July 2010

Hey! Who took my NHS?!

The coalition government published a White Paper on the NHS yesterday (12/7/10) called Equity and Excellence: Liberating the NHS, which promises a “bottom up” approach to NHS funding, a dismantling of unnecessary administration, targets and bureaucracy and (the usual) improvements in health outcomes, better care for patients etc. It will accomplish this by putting the majority of NHS funds (about 80%) in the hands of GPs, giving all NHS Trusts foundation status, granting the responsibility of public health to local authorities and getting rid of all primary care trusts (PCTs) and strategic health authorities (SHAs).

The White Paper is couched in cleverly worded language so that those outside the NHS and not privy to its organisational structure will not at first realise that what is actually being proposed is the effective dismantling of the NHS as an organisation and a move to privatising a public service. GP surgeries already operate as mini enterprises separate from the NHS. Trusts that gain foundation status are given power to operate outside the structures and targets of the NHS. The only other bodies existing as NHS organisations (PCTs and SHAs) are to be abolished. Put this all together and one is left begging the question: just what is the NHS anymore?

Initial reaction to the news has been cautious from professional bodies such as the BMA, the Royal College of Surgeons and the Care Quality Commission. The King’s Fund has been more vocal and the national press (Guardian, Independent) has had a field day. What has been most surprising about this White Paper is that it has seemingly come out of nowhere and how can we be sure that such radical changes will actually have a positive benefit on patient care? Are GPs really ready and equipped to take on such an enormous responsibility (on top of their already challenging work)? Do local authorities have the capacity to handle the public health remit? Who is going to make sure they are doing a good job? And most of all: Does the NHS really need another massive reorganisation?

All the pieces of this enormous jigsaw puzzle are not meant to be in place until 2013-14 at the latest but it is a blow to PCTs and SHAs, which are full of hard-working, knowledgeable and experienced managers and other staff who are committed to patient care and quality. As things stand now they will find it difficult to be taken seriously in the new world order and personally I think it is insulting to sub-title the document 'liberating the NHS' as if all managers and management structures are somehow holding the NHS back.

It remains to be seen in the immediate, medium and long-term how 'Equity and Excellence' will impact the NHS. I will be blogging later in the week on how I think these changes may affect medical library services. I have to agree with Andrew Burnham that the coalition government are taking an enormous gamble with the NHS as an organisation, with patients and with the lives of NHS staff at a critical time where none of us can afford to lose.

P.S. I also just want to point out for the record that Twitter was of enormous benefit when it came to the current awareness promotion of the White Paper to our library users. I was on alert all day waiting for the announcement to send the link out to managers, consultants and GPs as soon as it was published. Although we were able to watch the Parliament proceedings as they happened via BBC iPlayer (link) it was the Department of Health Twitter page which published the link first and I sent the publication out to our users a full 2 and a half hours before Andrew Lansley’s official email landed in our NHSNet accounts. Another example of why Twitter should not be a banned site in NHS Trusts!


  1. Thanks for the potted guide as I don't have the gumption to read the whole thing for myself - sounds like more NHS blah blah ... how many publicly-funded-coffee-and-sandwich driven committees spent how many hours writing this thing? At the end of the day what does it mean for patients ... whoops, sorry ... I mean customers ...

  2. Really interesting post. Keep blogging on this as I'll be really interested to get your take on this situation as it unfolds.