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FORUM - Opinion in the CNJ
 
Choice will benefit the NHS

Nick Bosanquet argues that Royal Free job losses are down to the government’s failure to implement NHS reforms

I LOOK back with pride on my eight years of service as a Labour councillor on Camden Council (1974-82) when I had the privilege of representing the good citizens of first Camden and then Caversham, Wards.
It was a tough time – the party was over and we had to find ways of getting more value for money. We did it through shifting support to voluntary groups and independent providers.
We also fought to give better service and more choice to the victims of state monopoly in council housing.
Now the party is over for New Labour and the NHS. The government has come to see that vast funding increases have led to small improvements in service.
We are still a long way from what is achieved in most developed countries – immediate access to all funded services: and the health gains of the last eight years in cancer and heart disease, although welcome, have been assessed by independent auditors as no better than in the 1990s.
There are many dedicated and caring professionals in the NHS who try extremely hard to make the system work as well as it does: but it is a huge, creaking bureaucratic system which has great problems in delivering value for money or adapting to change. The government is right to see competition and choice as the crucial next moves.
The choice programme for people waiting for heart surgery has led to big falls in waiting times.
The use of independent cataract centres has doubled the services. Closer to home the use of external providers has steadily improved care services for elderly people in Islington compared to the halting progress in a Camden which used to be a leader in quality of service or elderly people.
The usual argument against treatment centres is that they will cherry pick, leaving the hospitals with emergency work.
This is an argument not for staying with the current system but for using innovation to develop reliable alternatives to hospital admission.
Some nursing homes are already providing intermediate care and we need more providers in rehabilitation.
Reform urges more use of direct payments so that patients, carers and GPs could choose in areas where the NHS has clearly failed to provide as in hearing aids and stroke rehabilitation.
The Royal Free staff are the victims of the government’s lack of will to face up to the problem. In 2004 our first report on health funding showed the huge commitments that had been made in pay contracts, PFI schemes which went far beyond the funding available.
There is now a new problem of under funding. Staff that were recruited last year are now being laid off. Could there not be a clearer indictment, not of reform but of the old NHS system?
The transition to a new and more flexible system will be a difficult one. GPs will be leading the way and indeed they have shown how they can develop new services under the new contract.
At some stage NHS spending is going to come out of the period of super growth and we are going to have to face up to the problem of how to get more value for the health pound.
This must mean greater competition and new ways of making use of the limited amount of experienced staff time. Patient choice, foundation trusts, payment by results, and the new GP contract all aim to give power to patients, carers and local communities.
The old NHS was an economic flat earth programme – we have to find new ways of getting better services for patients and using professional time more effectively.

• Nick Bosanquet is Professor of Health Policy at Imperial College and the author of The NHS in 2010: Reform or Bust and The Economics of Cancer Care
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