England's NHS in 2013


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

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England's NHS in 2013

  1. 1. England’s NHS in 2013John Lister May 2013
  2. 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. 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. 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. 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. 6. The meanest of financial times6
  7. 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. 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. 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. 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. 11. It’s as simple as this!11
  12. 12. What about accountability ofnon-NHS providers (AQP)?12
  13. 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?”