Health and Social Care Bill

Memorandum submitted by Dr Rachel Wood (HS 71)


I am writing as I am very concerned about the far reaching changes proposed in the new NHS bill.   Whilst I acknowledge that there are challenges to running and keeping efficient such a vast organisation as the NHS I do not feel that the changes proposed by the Bill are likely to improve services and make them more effective.  I am worried that the Bill will fundamentally undermine the principles of the NHS and we could end up a huge variation in services commissioned by GP consortiums and less transparency and accountability of a publically funded service.  The concerns I have include:


There is currently no evidence base that GP's are best placed to hold the NHS budget and make commissioning decisions.  Many GP's and other doctors are also concerned about this and do not think they should have this role.  I think evidence for such an approach is needed before rolling it out on such a vast scale.


I am also concerned about such huge organisation change at a time when the NHS is facing huge cuts and cost efficency savings, I am worried about the amount of money that will have to directed to making such changes rather than running what is already an excellent and mostly efficient organisation.


If services can be provided by 'any willing provider' I am concerned that this will lead to privately run companies only taking on 'profitable' parts of the NHS and leaving other parts for traditional NHS services to run (with reduced budgets, cuts to services etc).   I am also worried that such cherry picking will lead to the NHS services being compared negatively to private providers.  Working for the NHS in mental health I am all too aware of the inadequacy of attempts to measure outcomes - as part of a multidisciplinary service we are measured solely on patient contacts which takes no account of the amount of consultation, liasion, supervision etc which makes up a huge part of our work. We work with a hugely complex group of people and often with those who are the most vulnerable in society and I am worried that some money for this group of service users is being re-directed into primary care.


I feel that bringing 'the business model' to the NHS will not lead to increased efficiency but money being spent on branding, marketing etc - at a time when huge cuts to services are already being made.  We do not want to become like the US where health care providers spend huge amounts on advertising, marketing etc pushing up the cost of those who can afford it's health insurance. 


I am also worried that 'any willing provider' being able to provide NHS services will lead to the loss of a shared sense of values and direction (if all these organisations are competing with each other) and lead to problems with sharing information, good practice and knowledge (I have already heard of examples where staff in one NHS trust have been told not to share information in staff in another because they are 'the competition).  Surely one of the strengths of the NHS is the huge amount of shared knowledge, experience and resources.  


Finally as a member of NHS staff I am worried about my own and my colleagues future careers, job stability and terms and conditions of employment.  Morale is low in the NHS as there is so much uncertainty about jobs and because Trusts such as the one I work for are slimming down to make them more 'competitive', services (that are needed) and jobs are under threat.  At present I am concerned we are moving away from an NHS with patient need at the heart (despite all the rhetoric about this).  I also trained to work in the NHS (that is free for all and where any profit made goes back into providing services) and would very much like to continue working for it.  I am worried that if these changes occur this may be under threat.


Please please listen to the concerns of people like me, ordinary people who believe that the NHS should be not be radically changed, especially at a time of huge savings.  Once these changes are made it will be very difficult to go back on them.


March 2011