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Dr. John Lister of Coventry University details the changes in public policy concerning England's public health system. (May 2013)

Dr. John Lister of Coventry University details the changes in public policy concerning England's public health system. (May 2013)

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  • 1. England’s NHS in 2013John Lister May 2013
  • 2. Disunited KingdomSince 1999, devolved government in Wales andScotland and later Northern Ireland have meantdiverging health care systemsEngland: testing ground for experimental market-style reformsFragmentation, competition, privatisationWales & Scotland: moving back towardsintegration – market model rejected, servicesbrought back ‘in house’Free prescriptions2
  • 3. Since 20003Labour govt’s NHS Plan starting point for 10years of major increases in fundingMore staff – nurses doctors, professionalsMore bedsReduced waits to maximum 18 weeksNew hospitals (privately financed through PFI)New structures for commissioners andproviders2008: hit the wall with banking crash
  • 4. 2008 to 201342009 McKinsey report – target of £20bn savingsby 2014 to bridge gap between needs & resources2010 last year of above inflation increases2010 onwards: Tory coalition govt. New drive forcuts and closures (“reconfiguration”)A&E under pressure: failure of primary andcommunity health care services & social careBeds and jobs cutMental health budget cut
  • 5. High profile cuts53 year pay freeze for 1 million+ NHS staffAttempts to break up national pay agreementSouth London Healthcare bankrupt:“unsustainable provider regime” invokedMid Staffordshire hospitals – scandal followed byadministration & cuts. But 55,000 protestNW London hospitals, etcSocial care cuts (local government cutbacks)Pressure for mergers/ impeded by “reforms”
  • 6. The meanest of financial times6
  • 7. Moving towards a market modelUnder Tony Blair, Labour combined increasedspending with market-style “reforms”:PFI to finance new hospitals & health centresFoundation TrustsPayment by ResultsIndependent Sector Treatment Centres“World Class Commissioning” – break upcommunity services for private, social enterprise,“any willing provider”Increasing bureaucratic costs of market7
  • 8. Tories crank up the paceHealth & Social Care Bill/Act: Far-reaching changeMassive Bill (400 pages), ComplexRemoves duty of Secretary of State to provide servicesConfusing language (e.g. amendment from “Any WillingProvider” to “Any Qualified Provider” – but no definitionof “qualified”.New structure: NHS England leading 200+ ClinicalCommissioning Groups ostensibly “led by GPs” butsteered by Commissioning Support ServicesNational Commissioning Board (NHS England) withsweeping powers & Local Area Teams8
  • 9. Creating a competitive marketNHS Trusts to become Foundations (pressuretowards takeovers/mergers etc: BUT OFTintervention creates problems)Foundation Trusts free to make up to 49% ofrevenue from private medicine & deals withprivate sectorRegulator and “Cooperation & CompetitionPanel” to enforce competition (+ integration!)Regulations to compel CCGs to open upservices to competitive tender/AQP9
  • 10. Regulation and CompetitionCare Quality CommissionMonitorNICEProfessional bodies (NMC, GMC etc)Cooperation & Competition Panel (Monitor)Office of Fair TradingCompetition CommissionEU Competition Law – “right to provide”10
  • 11. It’s as simple as this!11
  • 12. What about accountability ofnon-NHS providers (AQP)?12
  • 13. Plans to go much further13Cameron’s new health advisor Nick Seddon is leadingneoliberal from ‘Reform’ group, on record as wanting tohand over NHS budgets to private insurancePlans to enforce charges for “immigrants” usingaccident & emergency and other health services openway for wider imposition of chargesPersonal health budgets and budgets for social care inmental health and elderly care open way to top-up fees– and health insuranceNHS beds filled with emergencies, now delayingelective treatment: will increase use of private careHow long will NHS remain “free at point of use?”