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Opinion: Reality check

Opinion: Reality check
13 November 2013

Integration is the key to improving NHS services for patients but will marketisation allow that to happen?

Integration is the key to improving NHS services for patients but will marketisation allow that to happen?
Are the NHS reforms turning out as intended? I suspect Andrew Lansley shudders when he sees that NHS England, an organisation that he promised us would be ‘lean and light’, now has over 4,000 employees and is controlling from the centre as tightly as ever before. The promised end to red tape and absolute freedom 
for doctors and nurses to commission the services 
that patients need at a local level seems to have been a little 
As I travel around the UK on my new tour, I have met some GP commissioners who absolutely don’t accept that the NHS is being privatised and point to real benefits they have made for patients in their patch that they wouldn’t have been able to without their new powers. But the prevailing view, at least among my audiences, is that the reforms are a not-so-Trojan horse to put as many services as possible out for tender in a competitive market. 
But now NHS England has delayed the publication of its choice and competition framework amid a “paucity of evidence” of the benefit to patients. And although £9 billion of NHS business now belongs to the private sector (not including GPs, dentists and pharmacists), the predicted surge of private takeovers of community services has yet to happen. This could either be because commissioners are fighting to integrate and avoid tendering by a roll-over of services to existing NHS providers who are doing a good job. Or because the private sector is struggling to see where the profit margin is in NHS services to satisfy their shareholders. 
I have now switched from general practice, where I lost my job in 2012 after closure of a GP walk-in service, to hospital medicine, where I work as an Associate Specialist in a service for young people with chronic fatigue syndrome/ME. I’ve already been revalidated, not because the General Medical Council (GMC) had shown a special interest in me, but because my hospital, the Royal National Hospital for Rheumatic Diseases in Bath, is financially threatened. It was always too small to become a Foundation Trust, has a turnover of just £20 million and debts of £3 million.
On the plus side, it provides a fantastic service for patients with chronic pain, chronic fatigue and complex rehabilitation needs. It had the best response and highest scores in its friends and family tests, and the quality of the services is perhaps the only thing persuading Monitor to keep it afloat. But jobs are under threat and it was considered prudent to get revalidation done quickly in case services close. 
We’ve already had to close the excellent neuro-rehabilitation service, which really saddened me because if the NHS stands for anything, its supporting those who really need it and spending whatever it takes to put them back together again. I’ve no idea where the young people recovering from head injuries we used to treat will go now, but I do know that if a service isn’t profitable, it will struggle. So team meetings that used to be about clinical issues are now dominated by projected business forecasts. 
The NHS has to wake up to financial reality, but as I said to then-Health Secretary Andrew Lansley on a very angry Question Time in October 2011, there is no evidence that a competitive market in healthcare will make the service fairer, or better for those who need really complex care. We have to join up primary, secondary and social care, and reach out to communities and charities to help stop those tragic admissions that could be avoided for want of a changed light bulb. Integration and involvement are the key, and I for one would be happy to work for a merged primary, secondary and social care NHS trust all pulling in the same direction to get patients the right care in the right place at the right time. Is anyone outside Torbay commissioning that? 

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