Thank you for your query Maria, you may find some of our other work in this area of interest:
A vision for population health : towards a healthier future
What role do taxes and regulation play in promoting better health?
Is the NHS being privatised?
I do hope this is useful.
All the best,
I was under the impression that the act shifted the responsibility for the individuals health from the the state to the individual. This would have huge implications in the ability to dismantle the NHS.
Can anyone shed more light on this
Behind the Health Act and all of the reforms of a similar ilk is the ideological idea (rarely questioned now) that GPs are best placed to lead the buying of health services. I cannot remember why this presumption was given so much weight, but now it is simply assumed that the question is not whether or not GPs should lead, but rather how they should lead.
Why? What is it that qualifies a generalist, who might most accurately be described as a triage expert, to spend billions of pounds on specialised services? As I recall the idea came from a belief that as 80 per cent of patients stop at the GP surgery, without being referred any further, then GPs should 'know' their patient population better and therefore be better placed to design and deliver services for them.
But this is a presumption, not a fact, and it could equally well be argued that as 80 per cent of the NHS budget is spent in secondary care then it is specialists who ought to determine how best the money be spent.
Which brings us to the second reason in favour of GP-led commissioning, namely that as out of hospital services are cheaper, encouraging doctors to provide services in a primary care setting should produce savings. But again this is a presumption and it may well be cheaper overall to provide services in a single hospital setting than in a number of more local primary settings (as well as encouraging the kind of specialisation that we know improves outcomes).
In fact, the closer one looks at the rationale behind GP-led commissioning the more one might be reminded of Andersen's The Emperor's New Clothes – we are convinced of the truth of it not because we know it to be true, but because the powers that be tell us it is true. Until that is someone steps out of the crowd to ask why, exactly, the Emperor is butt naked! (And yes, I know that the government rebranded GP consortia as clinical commissioning groups, but in reality this hardly translated into a modest fig leaf.)
My question to Mr Dorrell was 'Is the Health Act the last ditch for clinician-led commissioning, and if so whatever shall we do next?' I suspect I may find out soon enough.
Most of us who have been following the story over here - such as me - actually do suspect that the two primary motivations were to spend less money on the NHS, and for the goverment to then say 'but you patients and your GPs made the choices yourselves'.
Well, perhaps I should say 'most of us over here, who are cynical like me'.
There still seems to be a very muddled piece of legislation, and only after a lot of amendments (not pushed by the goverment) are certain very obvious safeguards even slightly present - very few of the politically neutral, actually like this Act. Even if we agree the NHS might need to spend less money, it still looks like an untested (and untestable in advance) dog's breakfast ! And from a left-wing political perspective, I don't like profits flowing out from the NHS: the last major 'private business' involvement in the NHS was the PFI, and that is now coming home to roost with many PFI-funded hospitals in dire straits.
G.P's are not specialists but they will end up making decisions in care that will not be in the patient's interest ,I guarantee it.
What angers me more than anything is that Governments push through changes , testing out theories on populations who are powerless to stop it. Of. course Cameron hasn't told the people what the changes are really about, and the manipulation will trickle down until the doctors and nurses too will be manipulating the chronicly ill that the country can't afford them so this is all they are entitled to ,basic home care. Don't be surprised if the range of medications that can be used are cut back too in an effort to save millions of dollars. Our PHarmac organisation who decide what medications New Zealand can buy and who can use them, are ruthless. They stopped patients using a certian high blood pressure tablet which my Mother was on because her blood pressure is hard to control. The change caused heart failure with in two weeks, my Mother was than eligible to use it because of the heart failure--they could have killed her. It would be interesting to know just how many patients were adversely effected. My Mother rung a talk show about her experience on a morning when they had a representative on the show. The talk show host didn't have a hope in hell of arguing the case, pitted up against a doctor from Pharmac with his medical knowledge and ability to manipulate the talk show host backed down.
But it isn't my area of interest - but I am clear, that what we seem to have ended up with, is not what Cameron et al were stressing in their public speeches !