Reorganisation, Jim – but not as we know it!
Recent commentary in the BMJ, Nursing Times and the HSJ is critical of the reforms and predicts that, once the changes are introduced, we will be facing another major upheaval in five years' time.
Quite frankly it was ever thus! Having been a full time officer for 30 years in the NHS, I have lost count of the number of ‘reorganisations’ that have occurred to streamline the service, to make it more efficient, to improve quality/output/throughput or to save costs and improve the patient’s experience.
In some cases, the best and newest ‘big idea’ (reorganisation) had a shelf life that was measured in months, not years.
The irony is that each new reorganisation costs money, is detrimental to staff morale and, ultimately, has some effect in the way in which the public perceive the NHS as a public service.
But while there is reorganisation, staff continue to put on a brave face to ensure that the patient gets treated and cared for, which means that the general public can be forgiven for wondering what all the fuss is about.
So if the HSJ, BMJ and Nursing Times are correct and a reorganisation is on the cards in five years' time, do we need to care so much about yet another restructure that will slowly wither and die?
The answer is not to look at history, but to examine what this Bill intends to achieve.
Previous reorganisations have sought to restructure an existing service. This Health Bill seeks to dismantle what we currently have, fragment service delivery and the fabric of the NHS so that competition can drive down costs and allow key services to be sold. Alongside this, we have a National Pay Review Body examining ways to introduce local and regional pay and collections of employers across England trying to find ways to restructure or reinvent AFC.
Next week, the Government will return the Bill to the House of Lords for debate and will include some amendments to appease critics. Key changes include: strengthening the direct responsibility of the Secretary of State for Heath for the NHS; more say for patients for commissioning; a requirement that healthcare providers supply integrated services so that patient care is continuous; and for medical research to be a core function for the NHS.
With the exception of specifying a duty for the Secretary of State for Health to be responsible for the NHS, the other amendments do not change the thrust or key purpose of the Bill to continue to open up the NHS to a market economy.
You have to wonder what else would have been achieved if the Royal Colleges and others had decided not to sit on their hands and support the SoR and other unions a year ago when we argued why this Bill was bad for the nation’s health.
Some of the changes proposed by the Bill have the potential to seriously challenge our autonomy, but only if we let them. As key health professionals we are integral to the success of diagnosis and treatment. We are in short supply and we have bargaining power. The trick for SoR members is to recognise and exploit these strengths and not to rely on others to do this for us.
Possibly the real question is not will there be another reorganisation, but, If this latest reorganisation continues, and health is no more no less than a commodity for sale to the highest bidder, will there be an NHS to reorganise in five years' time?
Warren Town, SCoR Director of Industrial Relations
Click here to read the Royal College of Radiologists' statement opposing the Health and Social Care Bill in its current form.
Warren's recent blog also looks at whether GP dissention is too little too late to affect the Coalition's reforms to the NHS.