Friday, 5 April 2013

The end of the NHS? CCGs - Power to the People?

There have been many articles, headlines (I'm thinking The Independent, Cover story 2nd April) and Blog posts deploring the end of the NHS with the Health and Social Care Act which this week become Law. Our local newspaper had a large NHS advertisement published on the same day entitled "Shutdown of NHS Suffolk", likely to have scared the living daylights out of a large percentage of its readership. I even found myself succumbing to the inner panic such propaganda aimed to ignite, fearing an end to the healthcare my children currently rely on. So widespread has the panic been that surely it *had* to be the beginning of the end of our NHS?

My biggest fear was that encouraging GPs to commission services was an ideal about forty years out of date. What practice has a stable and unchanging group of GPs these days? Every time I visit our surgery there has been a turnover of approximately a third of the GPs, some of them only GP Registrars. Long gone are the days of a "Family Doctor", a local GP who knows his or her caseload and looks after families for years, getting to know them and their needs. Just HOW are an ever-changing group of professionals, several only locums, going to have any inkling as to what services may be required in a particular area? It might have worked beautifully in bygone days, when the NHS was in its infancy and demand was substantially lower but I was slightly alarmed at the premise that today's society could support such change.

I am however a true Liberal, in the old sense of the world. I abhor Big Government, prefer self determination and am rather scathing of men in suits with little or no experience of my life making decisions which impact on me at every turn. Any semblance of decentralisation was bound to grab my interest.

So I took my head out of the sand, and decided to read. I'm barely past the first few pages but I am already feeling considerable reassured. Take Ipswich and East Suffolk. I visited our GP Clinical Commissioning Group page, and clued myself up.... breathing a huge sigh of relief. Here at least, I can see this revolutionary overhaul might just actually work. On the Clinical Executive, and the Governing Body, were names I recognised. People I knew. Most importantly professionals I respect and admire. GPs who are senior partners at the best practices in our area. There are two or three extremely successful large medical centres in our CCG. These have bought in services to support their community which have taken considerable pressure off local hospitals (ECGs done at Hadleigh for example) and speeded up routine testing. The Senior Partners for these Centres are now involved in making the new system work, and after 14 years watching at least two of them have such positive impacts on their own surgeries I am considerably more enthusiastic.

The best "bit" of the new changes, which really are revolutionary, is that the Men in Suits are almost obsolete. Politicians and Civil Servants now have less say in local healthcare, which is in the hands of the health professionals. I'm not sure there is an ideal, but I certainly wish someone had a similar idea for Education. How many teachers are sick and tired of being dictated to by Westminster and Whitehall? Politicians and Civil Servants Hell bent on "making their mark" in a Department they will have four years in at best, and in an area they have little expertise. I totally support the concept at least of devolving power to local areas to commission healthcare as they see fit. Obviously you don't want to subdivide areas into such tiny blocks that their bargaining power is reduced to little more than a whisper, but cutting out the middle man so to speak, or reducing his influence has to be a good thing. Too much money is wasted on management within the NHS and almost every area of the public sector. It's not only saving money (hopefully!) it's placing the purse strings and decision making in the hands of the professionals.

The cynic in me doubts it can be accomplished without a variety or problems, not least the apparent incompetence of almost every government in history to effect such sweeping change without making a few catastrophic miscalculations. I and the rest of the country live in hope this isn't one - and reading between the lines I suspect the Labour party actually wish this too. Overturning such a far reaching Act would be politically, financially and practically  challenge of enormous magnitude.

My biggest current concern is over data sharing, resolving the current mostly appalling communication lines between primary, secondary and tertiary care. Between community and hospital professionals, and above all from and to GPs. Hospitals like Great Ormond Street get their clinic letters typed in India - and some of ours have been sent to Ipswich Australia when a well intentioned typist googled "Ipswich Hospital"! Excellent communication is vital, it's the key which will make or break this new system. Because if GPs are not aware of 100% of a patient's healthcare they will NOT be best placed to commission appropriate services.

So I hold my breath and wait, and watch. I sincerely hope this is the major step forward it has been flagged up to be - because the NHS certainly needs to evolve from the elephant wading through custard   experience most of its users have.

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