British government plans major health care overhaul, but critics say changes could cause chaos

British government plans major health care overhaul, but critics say changes could cause chaos

Jill Lawless
Associated Press
January 17, 2011

LONDON - Prime Minister David Cameron on Monday waded into terrain where past British governments have foundered, promising fundamental changes to the country's expensive and over-stressed public health care system.

Cameron said the reforms would cut red tape and improve treatment, but critics claim they will cause chaos and could lead to backdoor privatization of the much-criticized but widely popular National Health Service.

The British leader, whose Conservative Party heads the country's coalition government, said he would save money and cut red tape by giving control over management to family practitioners rather than bureaucrats, and allow private companies, charities and social enterprises to bid for contracts within the public health service.

Making health care more efficient has proved an elusive goal for successive British governments. The previous Labour administration vowed to reduce waiting times for treatment, and succeeded — but at the cost, say critics, of wasteful bureaucracy.

In a speech outlining the government's plans to overhaul public services, Cameron promised to get rid of "topdown, command-and-control bureaucracy and targets." He said that with an aging population and growing demand for new medical treatments, "pretending that there is some easy option of sticking with the status quo and hoping that a little bit of extra money will smooth over the challenges is a complete fiction."

The government is due to publish details of its reforms in a Health and Social Care Bill on Wednesday.

Socialized medicine is as much an article of faith in Britain as it is a divisive flashpoint in the United States.

The health service is Britain's biggest employer, costs more than 100 billion pounds ($158 billion) a year — and is a political football, reformed and criticized by governments since it was established in 1948.

Despite the constant tinkering, no major political party proposes privatizing the health service, and even free-market politicians like Cameron go out of their way to praise it.

Cameron's Conservative-led coalition government has said health care will be spared the cuts imposed on other departments as part of a 80 billion pound ($128 billion) reduction in public spending through 2015 designed to reduce Britain's huge budget deficit — and bring the biggest overhaul in decades to public services.

On Monday Cameron said "a free NHS at the point of use, for everybody" was "part of Britain, part of Britishness."

He spoke of the care received by his son Ivan, who died in 2009 from cerebral palsy and a rare and severe epileptic condition, and the medical staff who delivered his baby daughter Florence last year.

"All of them have touched my life and my family's life in an extraordinary way, and I want to do right by them," he said.

But while some doctors welcome the government's changes, others claim the scale of the reforms — which will see consortia of doctors take over management from local health care trusts — could cause chaos.

In a letter published Monday in The Times of London newspaper, groups including doctors' body the British Medical Association, the Royal College of Nursing and trade unions — which together represent many of the more than 1 million NHS employees — warned that the scale and pace of reform made the changes "extremely risky and potentially disastrous."

The letter said increasing internal competition meant that "with scarce resources there is a serious danger that the focus will be on cost, not quality."

Despite the constant tinkering, no major political party proposes privatizing the health service, and even free-market politicians like Cameron go out of their way to praise it.

It would be political suicide for anybody to suggest otherwise. One of the many reasons that Major's Tory government failed was because it had been slowly strangling the NHS.

And I wouldn't say that Cameron was free market, at least not as Americans would understand it. He is all for deregulation and getting rid of red tape, but he is also an advocate of social responsibility by everyone toward each other.

Despite the problems, the NHS works very well. No other system in the world provides as broad a service as it does in terms of socialised healthcare. My wife will probably tell you, as I can say with confidence (because I worked in a large hospital for two years), is that the only problem is too much bureaucracy. Some Americans may sneer at our system and use inflammatory terms to describe it, but overall it works very well. It is not a house of cards that one small problem means it is completely useless, but it obviously needs improvement.

I remain to be convinced that surrendering control of the local PCTs directly to GPs is a good idea though.

My major concern with this is that a very similar thing was tried in the 90s and then abandoned. The PCTs were set up precisely because the GPs didn't want to have to spend their time attending board meetings, doing admin and making decisions about budgets when they should have been treating patients.

The PCTs will have to be replaced with something else, some of their responsibilities will be shifted to local authorities, smaller replacements will be set up in the counties/regions but for the most part - GPs will have to hire in private companies to take over admin, budgeting, etc. I don't think the Tories are trying to introduce privatisation by the back door, but in my experience allowing the public sector to sublet their duties to private companies is usually a mistake. They do it on the cheap. The chain of command is blurred. Different standards exist, etc. Also, the power to hire these companies is placed - not in the hands of businessman - but in the hands of doctors. It's all very well to say their placing the power in GPs hands, but they're placing far more pressure and responsibility.

This has been tried. It has failed before. There's a good chance this will be a failure and an expensive one to boot. And considering the work still has to be done, I fail to see where they expect to make any savings on this venture. What we needed more than anything right now with regards to the NHS is stability. That was precisely what the Tories promised to provide. The White Paper was a massive shock to everyone in the NHS. I think these measures will be an expensive and damaging mess and that's the absolute last thing we need right now.