What's happening to the NHS?! - An introduction

The NHS is a huge organisation, with many complex issues that are certainly not new. We have always loved to talk about the NHS in the media, it is a staple part of British life, and praising and at the same time complaining about it is commonplace in all parts of society. Going forward it is important to remember that whilst the NHS has certainly not been perfect, for the last 65 years Britain has had of the most equal and efficient healthcare systems in the Western world.

Pritchard C, Wallace MS. Comparing the USA, UK and 17 western countries' efficiency and effectiveness in reducing mortality. Journal of the Royal Society of Medicine Short Reports. 2011;2(60).

So what makes the changes happening now so important?

The current British Government has launched an unprecedented, full-scale transformation of the way that NHS services are purchased, structured and delivered in the UK. Most of this change came about through the Health and Social Care Act 2012, but there are many other pieces of legislation and considerations that will change the shape of the NHS in future. This is simply an introduction to some of the issues that will affect the NHS in terms of equality of access and its ability to address health inequalities in the UK, which are now as unhealthy as ever. These issues can be thought of in terms of:

Structural Changes

Privatisation

Accountability and transparency

Migrant health issues

1. STRUCTURAL CHANGE

The Health and Social Care Act 2012 abolished previous commissioning bodies (the groups that decide who provides healthcare) in the NHS and replaced them with GP-led ‘Clinical Commissioning Groups’, or CCGs. The structure of public health provision in the UK has also changed, with powers being handed to local authorities. This is a very large undertaking, but the question is, will it affect healthcare? Important issues to raise are:

• Will there be adequate patient/carer/public representation when commissioning decisions are made?

• Do CCGs have the power to choose the option that will be best for the health of their population, which may not be the cheapest option?

• Will there be adequate regulation of ‘tendering’ to ensure that decisions are made in the public interest?

• Are local authorities equipped and able to address public health issues? Is a divided and localist approach a step forward?

2. PRIVATISATION

A fundamental change in the fabric of the NHS was made in the Health and Social Care Act 2012, which now allows CCGs to purchase services from ‘any qualified provider’. Exactly what ‘qualified’ means is not entirely clear but the overbearing impact of this change is that contracts will be available to private healthcare providers, for profit. This has already happened in many parts of the country and signifies the beginning of large scale marketisation of healthcare in the UK. This raises many issues, for example:

• Why should public money pay for the profits of private companies when it could be spent on care?

• Private companies are legally bound to serve their shareholders’ demand for short-term gains in profit, does this fit with the NHS’ duty to serve the health of the population in the long term?

• The possibility of ‘top-up’ charges and health insurance premiums is already being discussed by politicians and private companies. Poor people are less likely to access healthcare if they have to pay for it and this will widen inequality.

• The introduction of private competition will mean that companies have to market themselves, which is expensive and inefficient. It also requires a large amount of spending to regulate not only the market itself but the companies operating within it.

3. ACCOUNTABILITY AND TRANSPARENCY

The new NHS structure does not give adequate accountability to those who will have a huge impact on the future health of the population. There is also a lack of transparency in the decision making processes involved. The following are a few crucial issues:

• The Secretary of State is no longer responsible for providing a comprehensive health service to the people of Britain. This means that ‘holes’ in provision may have to be paid for and there is no limit to how big these holes may become.

• How do we hold private companies to account to ensure that the best is done for the health of the population? How do we measure success or failure?

• The money that will go to private companies is public money, yet details of how it is spent is private information. This must change.

• The details, discussions and decision-making processes surrounding ‘tendering’ and commissioning in general should be publicly available and accessible.

4. MIGRANT HEALTH ISSUES

The ‘Immigration Bill 2013/14’, proposed by Theresa May, is currently standing before Parliament. If it is passed, ‘temporary migrants’ would be forced to pay for access to healthcare in the UK. 75% of these ‘temporary migrants’ affected will be international students and it will also cover asylum seekers and refugees. It risks doctors having to act effectively as ‘border police’ and this is unacceptable. It should be important that:

• Everyone in the UK has access to healthcare. Refugees and asylum seekers already have significant barriers to accessing services in the UK and we should be promoting the health of these people, not refusing it. The impact on the health inequality experienced by these groups could be profound.

• International students, as a huge contributor to our country not exclusively in terms of research and funding of our educational institutions, are not alienated and made less likely to see a doctor.

• We do not feed a growing xenophobic attitude in British society, which serves to divide communities and create social problems where there should be cooperation and integration.

If you want to get involved in tackling any these issues, great or small, then get in touch at nhs@medsin.org, keep an eye on this blog and join us on Facebook at facebook.com/studentsforthenhs.