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Cameron's broken promise is a threat to care of patients; DANGER BEHIND NHS REFORM U-TURN.


WITH its proposed NHS reforms, the Government might be most warmly congratulated.

This week it publishes its Health and Social Care Bill, following its beautifully written White Paper, Liberating the NHS. So now, finally, the NHS is to be freed.

This document's honeyed tones and warm aspirations are sweetness and light - but those expressions of good intentions will easily deceive those of us that are less well informed.

The one thing that most health professionals agree is that the NHS does not need another reform.

This is precisely why, when in opposition, Prime Minister David Cameron promised to halt the merrygo-round of organisational change inflicted on the NHS.

And this promise, about to be broken, was effectively countersigned in a pledge by Nick Clegg, now the Deputy Prime Minister.

We have already learnt about the trustworthiness of this Government.

It is introducing great swathes of legislation as rapidly as possible, for which it had no mandate from the electorate.

Promises have been broken on tuition fees and it is engaged in enforcing changes in the electoral system that may be to its advantage, but have not been fully scrutinized by Parliament.

In the case of the NHS, this is no mere minor merry-go-round.

It means a rapid reorganisation in which all primary care trusts are liquidated, all hospitals become foundation hospitals, strategic healthcare authorities are abolished and the responsibility for public health will be with local authorities.

In this battle for the NHS, more than three-quarters of the pounds 100billion NHS budget will be devolved to general practitioners for administration.

Yet GPs show the least interest, and have the least experience in coping with such massive changes. We have heard much about the financial legacy left by the previous Government.

This negative message has been the cornerstone of an excuse for the severest cuts in public spending in living memory. Yet can we trust Government pronouncements? If their pledges on the NHS reforms are void, so are their promises on the ring-fencing of NHS funding. Indeed, these reforms will cost substantial public money.

In spite of Government assurances, the NHS is already being cut. Managers have been told to find pounds 20billion in efficiency savings to avoid widespread closures. In London, where so much research, teaching and training leads to the excellence of the NHS, we face a 14% cut in junior hospital posts. And 70 key training posts in general medicine out of 300 are to go, with another 70 posts from the other specialities cut by 2014.

The King's Fund calculates this reorganisation will cost between pounds 2billion and pounds 3billion. It will, of course, be taken from patient services.

But the pressure of population change, the incidence of chronic illness, the rising age of our population, inflation and the rising expectations of patients all mean further shortened resources.

And the massive cuts proposed in social care and welfare services will mean increased pressure on what is now an underfunded NHS.

We have heard how research will be protected from cuts. Here is more sleight of hand by the Government.

Healthcare research is not just funded by the NHS or the Medical Research Council. Increasingly, many research funding bodies, such as the Engineering and Physical Sciences Research Council, make important contributions to crucial advances. Yet the Government has not been quite so forthcoming about whether these bodies will retain their full funding.

The dulcet tones in the White Paper, with its emphasis on patient choice, are a smokescreen. Of course patients would like choice, whatever that means, but what they really want is efficient medical care.

I recently visited one of the most famous maternity hospitals in the country to see a close friend, Janice. She had given birth to a premature baby at 34 weeks.

Her GP had given her the choice of three hospitals and Janice chose this one. Four days after delivery, she had still not seen a doctor even though her blood pressure remained so dangerously high she could have had a seizure.

I went to see the nursing staff and asked to speak to one of the house surgeons. Attracting the attention of any nurse was difficult, because they were all doing paperwork. No junior doctor was available, so I finally asked to speak to the registrar. It is difficult to believe, but none of the staff knew the name of the registrar - the doctor ultimately responsible for all immediate decisions.

I had to phone the switchboard to find out the name of the on-call doctor and only when I left the hospital was there a sudden outpouring of care as three doctors visited the patient in about five minutes.

If we really want to improve our health service, we should learn from Janice's experience. We need doctors who work in teams and ensure proper continuity of care. We must have GPs whose key role is to see their patients - not diverted by running the NHS machinery. And we must make certain excellent nurses are properly valued - more involved with patients and less with paperwork.

LORD Robert Winston is one of the world's most highly respected doctors and scientists. Well known for presenting TV shows such as Child of Our Time and The Human Body, his numerous acedamic positions include Professor of Science and Society and Emeritus Professor of Fertility Studies at Imperial College London.


AILING Wards will be underfunded
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Publication:The Mirror (London, England)
Date:Jan 18, 2011
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