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Politic and the GP… Where We Stand Dr. Sarkar GP Registrar VTS Teaching Feb 2012 Aneurin Bevan NHS Core Principles The NHS was created out of the ideal that good healthcare should be available to all, regardless of wealth. When it was launched by the then minister of health, Aneurin Bevan, on July 5 1948, it was based on three core principles: – that it meet the needs of everyone – that it be free at the point of delivery – that it be based on clinical need, not ability to pay Why change? • Rising demand and treatment costs. • Need for improvement. • State of the public finances. Health and Social Care Bill 2011 • Introduced in the House of Commons on 19 January 2011 • Proposes extensive reorganisation of the structure of the NHS in England • Abolish PCT and SHAs and give £80bn healthcare budget to CCG run by GPs- slashing NHS management costs by 45%, and reducing the number of arm's length bodies, or quangos. • Make the NHS more accountable to the public • Healthwatch Patient involvement • Monitor – regulatory body • Foundation Trust Hospitals -Tony Blair • Public Health England- to improve public health and reduce health inequalities Why are people annoyed about this? • not discussed during the2010 general election campaign • not contained in the 20 May 2010 conservative-liberal democrat coalition agreement • "stop the top-down reorganisations of the NHS that have got in the way of patient care". Public Health • Duty to Provide a NHS throughout England would be lost. • CCGs not bound by “duty to continue to promote a comprehensive free health service” • Secretary of State’s accountability to parliament for the provision of services would be diminished. • Parallel system of public health services will be established at a local level, assigned to local authorities (immunisation, mental health, sexual health drug and alcohol services). Ill defined and services may be chargeable. Sir Michael Marmot President of BMA BMA • • • • • • • • • • Oppose whole Bill Improvements don’t require legislation Health service already facing massive financial challenge distraction from efforts to ensure and improve the quality of patient care. the powers of the NHS Commissioning Board over CCGs as outlined in the Bill appear overly restrictive and seem to undermine their autonomy. practical implementation and how individual components within the reforms will work together. The consequences of change have not been properly thought through in a number of areas- public health delivery and the provision of education and training for clinicians are being pursued alongside the Bill. the Bill sets out new responsibilities for Monitor, the NHS Commissioning Board and CCGs in relation to promoting and managing patient choice while a major roll out of the ‘Any Qualified Provider’ policy is already underway without any need for legislation. Government’s stated aim of reducing unnecessary bureaucracy is looking increasingly meaningless as new bodies and structures are created with increasingly complex interrelationships. Much of the detail is being left to secondary legislation and guidance which has also meant that the overall picture remains vague and incomplete. Clinicians have repeatedly raised concerns about the chaos they are already seeing on the ground as more and more change takes place. Dr Clare Gerada Chair of RCGP RCGP • Royal College of GPs (RCGP) to call for withdrawal of the Health and Social Care Bill. "The RCGP statement seeking withdrawal of the Health and Social Care Bill surely scotches, once and for all, the Government's claims that there is professional support for this deeply flawed, damaging and unnecessary legislation. “Whilst GPs and other clinicians support the concept of clinically-led commissioning, they do not believe that this expensive upheaval of the health service is needed to achieve that. If the Prime Minister really wants to put clinicians in control he should listen to what they are saying - louder and louder each day - and put this increasingly confused legislation out of its misery." Adrian Fawcett Chief executive officer of General Healthcare Group, the biggest private healthcare provider in the UK $ $ Private sector • No cap – other bodies worried. • govt think this will inc competition and therefore imp patient care as well as driving costs down. • Comp on service standard currently … will move onto price, Dr Agnelo Fernandes Charities • The King's Fund seeks to understand how the health system in England can be improved. Using that insight, we work with individuals and organisations to shape policy, transform services and bring about behaviour change. • The King's Fund has called on ministers to reconsider the speed and scale of new health reforms warning of "significant risks" at a time of increasing financial pressures for the NHS. • In its response to the government's White Paper the think-tank said the case for radical reorganisation had not been made to justify these measures. • Therefore it said reforms should be rolled out more slowly if ministers are to deliver lasting benefits to patients and improve NHS performance. Andrew Lansley Earl Howe Parliamentary Under Secretary of State at the DoH Earl Howe • Amendment • Change the limit on private income for NHS foundation hospitals from 2% to 49%. • Hospitals could use their beds and theatre time for the health care of paying individuals and insurance firms • Care must be based on clinical need, not the ability to pay. Your Opinion