14 Jul 2010

NHS white paper: liberating the health service?

Health and Social Care Editor

What is the significance of the changes announced this week in the NHS white paper? Channel 4 News social affairs correspondent Victoria Macdonald answers your questions.


What will be different for patient care on the first day of the new NHS?

Not a lot. Which is a surprising thing to say considering the coalition government is selling its white paper as the most radical shake-up of the NHS since it was formed more than 60 years ago.

So when we will notice the change?

Most experts are encouraging Health Secretary Andrew Lansley to slow down and take a breath because all these changes are effectively being introduced without any real testing that they will work and will bring about better care for patients.

Nevertheless, the proposal is that as much as 80 per cent of the NHS budget will be in the hands of family doctors by 2013. So there are three years to sort this out.

What will GPs do with the budget?

GPs will take over from primary care trusts and purchase large chunks of care: hospital admissions, ambulance services, district nurses, physiotherapy, out-of-hours care. What they will not be responsible for is public health, maternity services, pharmacy, opthalmology and dentistry.

So who will look after the bits the GPs do not?

That is not clear. The white paper says local authorities will take a bigger role in public health, although there is already anger over this, with experts pointing out that obesity, for instance, is one of the biggest health issues facing the NHS.

How will GPs control their funds?

England’s 35,000 family doctor practices will form themselves into about 500 consortia, based on geographical area. So they could be responsible for patient populations as large as one million and as small as 100,000.They will either manage themselves or, more likely, will take on managers from the PCTs and strategic health authorities, which are also being abolished. Alternatively, they can take on a private company to manage them, and there are several waiting in the wings for his opportunity.

What happens to hospitals?

Hospitals will all be required to become foundation trusts by 2014, giving them more autonomy and freedom as to how they provide their services. They can also borrow money without asking the Treasury, and Mr Lansley is very keen that many form themselves into “mutual trusts” a lot like John Lewis, in which staff run the centre.

But what are the chances of them closing if they do not control their budgets?

Mr Lansley was adamant that “We have to face the fact that not all organisations will succeed.” But never before in the history of the NHS has a health secretary willingly stood back and watched a much-loved hospital go to the wall.

Equally, it is inconceivable they will stand by and allow GP consortia go out of business, leaving patients without a doctor to go to.

Who will step in if it looks like this is going to happen?

Overseeing all this will be the NHS Commissioning Board, which will be independent but will have a responsibility to step in if they see there is a risk of failure in an organisation.

Is this not the slippery slope to privatisation of the NHS?

Some think so, and the coalition government has predictably clasped the private sector to its bosom and is allowing them opportunities to step into the new regime.

What is not clear is what happens when a profit is made or, equally, when a deficit is run up. This was one of the surprising details missing from the white paper.

What will happen to out-of-hours care now?

GPs do not, on the whole, like doing out of hours care, and were happy to be able to hand it over to private companies who hired in locums. Mr Lansley wants them to take back this responsibility, but this could be one of the many areas where family doctors dig their heels in.

What say will patients have in all of this?

Andrew Lansley says “no decision about me, without me” is at the heart of the white paper. Patients should have more choice, and to this end he has promised to scrap “top-down targets” in favour of measuring standards and performance through collecting information on treatment outcomes.There will be information on things like MRSA rates, but patients will also be asked for their experience during their care.