Health and Social Care Bill

Memorandum submitted by Dr Naomi Elton (HS 07)

Dear Committee Members

I have worked as a Consultant in Child & Adolescent Psychiatry for 15 years. I currently work for an NHS trust, and while my views about Equity and Excellence are shared by many colleagues I am not in a position to represent the views of my employing organization.

My concerns are two-fold.

1. I am very concerned about the likely effects on patient care should the changes outlined in Equity and Excellence be enacted in the Health and Social Care Act. Firstly, it seems clear that the re-organization itself will be very costly. There is little hard evidence that a re-organization along the lines proposed would render a system that would be more cost-effective than the status quo. The numbers of GP consortia will be far greater than the numbers of existing Primary Care Trusts so it is very hard to see how management costs within the envisaged system will be reduced. Most GPs will not have the skills or time to engage in commissioning, so will be forced to delegate commissioning to other organizations. In a competitive market, multinational companies may well be the most successful contenders. If such organizations take on the commissioning, I believe that commercial interests will inevitably constitute a very significant influence over the process and its outcomes. There is little good evidence to allow us to believe that patient choice or more accurate assessments of the local health needs will be outcomes of the envisaged changes as the bill intends, and the opposite is in fact more likely.

2. A further concern is that, as the recent Kennedy Report makes clear, children’s services are in desperate need of integration. In their day to day work, practitioners must work together, and when they fail to do so, this is to the very great detriment of the patient. Proper co-operation between practitioners is unlikely to be accomplished by putting the provider organizations into a position in which commercial interests foster high levels of competition.

I trust these comments will be useful. 

February 2011