One of the sad facts about the swathing cuts Health Minister Andrew Lansley is wielding is the negative impact this will have on the health of the population in England.
Ask anyone in the NHS - whether frontline, support or backroom staff; whether commissioner or provider; whether local or regional - and one thing they will tell you is that dealing with structural change takes away from doing the day job. This applies, whether or not the changes being undertaken are good for the nation's health (e.g. some targets, such as the 18-week target or smoking cessation), or, like the nonsense that underpins Lansley's current efforts (e.g. the notion of "efficiencies").
Of course we should be ensuring that public services, like any other, are as efficient as possible. But to deny the fact that, for years, the NHS has been not only seeking, but delivering efficiencies year on year, would be crass. PCTs and Health Trusts have been "rationalising" backroom functions and layers of management cumulatively. Yet Lansley insists on peddling an image of a bloated NHS with wasteful managers in PCTs doing nothing and being paid astronomically for it.
Some questions Lansley might usefully consider answering honestly include:
1. Which layer of the NHS has delivered value for money in the provision of secondary health, through year on year rigorous commissioning and close monitoring against contracts? (Answer - the PCTs he is demolishing)
2. Which layer of the NHS has reduced the gaps in health inequalities (that mean that people in the same region can have life expectancies 10+ years worse than others) through the targeting of services at the most vulnerable? (Answer - oh yes, it's those PCTs again)
3. Which layer of the NHS has the talented workforce with the skills to commission robust secondary care that meets the needs of local populations, rather than pretending we can all have an NHS built around our individual needs? (Answer - PCTs, with their expert commissioners)
Lansley asserts that GPs are "best placed" to commission health care in England, because they know the needs of individual patients. The reality he chooses to ignore is that any health care provision that comes from a finite resource (a resource, by the way, the coalition is reducing, in real terms, against the rising demands of an aging society) requires my needs to be measured against those of my neighbours and others. The proposed GP consortia will struggle to deliver the influence and pressure PCTs have delivered in screwing the best value out of providers because of this lack of scale.
And please, do your best not to have a rare condition in the second half of a financial year. In the first half, you may get lucky with your GP spending well above the allocated amount of money on "your" healthcare, to give you an appropriate, but expensive intervention. But when the year is halfway through, and the consortia are over-spending without a bail-out from Lansley, because they do not have the detailed financial skills to manage finite resources that reside in PCTs, don't expect to be able to get the same high-cost treatments.
I predict that, by the end of this parliament, the health of the weakest and most vulnerable will have deteriorated; the so-called postcode lottery for treatments will be more stark than ever before; and that a fresh NHS restructure will be looming. And Lansley will have achieved the Tories' aim of beginning the systematic breaking apart of one of our most treasured and necessary institutions - an NHS free at the point of delivery for all.
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