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NHS reforms will have little effect on patients, says academic

Patients will see “little difference” when the government’s controversial NHS reforms come into force later this year, a policy expert has said.

The Health and Social Care Act, which became law after a tortuous passage through Parliament, is expected to cost the taxpayer between £1.5bn and £1.6bn to implement.

But Nick Black, professor of health services research at the London School of Hygiene and Tropical Medicine, said when the reforms come into force on April 1 patients will not notice a great difference in services offered to them.

The main aims of the health reforms were to make the NHS more accountable to patients and to release frontline staff from excessive bureaucracy and top-down control.

One of the biggest changes is the move from primary care trusts (PCTs) to clinical commissioning groups (CCGs), which will be led by GPs and other clinicians who will take on responsibility for commissioning care. The move will see 212 CCGs replace 151 PCTs across England.

A new national NHS Commissioning Board is responsible for setting commissioning priorities for the groups and oversees England’s NHS spending. For the year 2013-14 the board is responsible for £95.6bn of the health service’s budget.

“On 1 April patients won’t notice any great difference in the services available and that they receive,” said Professor Black.

“In essence, CCGs will commission care locally instead of PCTs - not that patients have even heard of such bodies.

“While it is hoped that commissioning has a stronger clinician involvement, the decisions made are unlikely to be strikingly different from the current ones because there isn’t much room to manoeuvre.”

But the Department of Health said that CCGs are already improving the care of patients.

“Clinical Commissioning Groups are already improving people’s health and they are making it easier for patients to access services,” a spokesman said.

“The changes we’ve made also encourage better integration between health and social care services.

“We are putting those who know the needs of their patients in charge of their healthcare.

“Our reforms give doctors and nurses the power and the freedom to provide healthcare services that they know their local population need.”

Professor Black continued: “What matters now is that the system looks at new ways of providing care that are more patient-centred.”

He said that if health care professionals took the time to really discuss patient’s problems with them it could save time - and money - in the long run.

“If we start involving patients in decisions about whether or not they get a surgical treatment - such as a hip replacement - patients are less likely to opt for surgery than surgeons.

“The more people understand about their illness the better they are able to manage it themselves.

“If doctors take a little more time talking and explaining about illnesses it could save so much time by preventing the costly treatments further down the line.

“It has got to be about helping patients understand what is wrong with them and what the likely outcomes are.

“We have to change the balance so it is much more about the patient making the decisions.”

Professor Black added that it is too early to tell whether the efficiency drive in the health service has had an effect on patient care.

He said the true effects will not come to light until the late spring or summer.

The NHS has been charged with making £20bn in efficiency savings by 2015 - in the last year the health service made £5.8bn in savings.

“We have not yet seen any of the effects,” he said.

“The fact that there is nothing to report yet does not mean that there is not some harm occurring - there might be - but equally there might not.

“When we have got the full data for the current financial year then we can expect to see some impacts.”



Readers' comments (29)

  • michael stone

    I'm not so sure about this - hasn't one council today proposed telling its GPs to not offer treatment to some patients unless they agree to go on 'life-style improvement' courses ?

    Isn't it unclear how moving some responsibilites to Local Councils will impact ?

    What seems clear to me, is the 'more power at the GP+patient level' seems to have been much diluted compared to the 'promise' (but I might be wrong - this one isn't my specialist interest).

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  • tinkerbell

    “If we start involving patients in decisions about whether or not they get a surgical treatment - such as a hip replacement - patients are less likely to opt for surgery than surgeons'.

    Have i misinterpreted the above?

    Hip replacement crisis looming one wonders. I'm sure the surgeons aren't currently just doing hip replacements willy nilly because they're bored but because there is a clinical need. Hmmm?

    Or are they suggesting that surgeons would rather operate on themselves than patients?

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  • Unless in an emergency or unconscious when I hope one can fully trust the medical and nursing professions, I most certainly would not accept any treatment unless I was consulted and involved in the decision making. Patients have to give their consent to any intervention, no?

    there is always the danger as in insurance paying schemes like some countries in Europe where hospitals and doctors tend to over investigate and treat to recuperate their costs from insurance companies.

    I would be very wary indeed and would never consent to anything without first knowing the alternatives.

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  • The NHS is getting between 10 and 30% unpaid overtime every week out of both nurses in our household. This has got progressively worse over the past 2 years as the changes start to happen. We have yet to see ANY benefits for patients or increase in the clinical input to the way the NHS is managed. If anything the reverse is true, with so little time for the remaining clinicians to care for patients, meaningful input to clinical networks and the like has all but disappeared.

    An increase of 34% in the number of local health organisations to deliver £20bn savings seems a strange way to go about it. The only winners out of this (amongst many other) reorganisations is the managers, accountants and lawyers.

    No doubt there will be mergers of CCGs as there was with PCTs as they find they are too small to have the critical mass to negotiate a meaningful contract with care providers.

    This appears to be about making the NHS as inefficient as possible to make privatisation look like the only feasible option. Much as was done with the railway industry. However privatisation does not deliver cost savings AND quality improvement plus PROFIT. Simple mathematics will tell you that is not possible. The only rail network delivering a real profit is the East Coast (in public hands) the private sector ones are all getting a "government" subsidy (so they still get a profit!).

    This appears to be all about delivering a return on investment for shareholders, not better care for patients. Many contracts are being let to private providers as pseudo NHS organisations misleading the public that they are NHS organisations. GPs are of course one of the longest running examples of this! Relatively few are NHS employees and they are business people with profit one of the major motivators.

    We have seen with care homes that even with regulation and inspection, profit comes before care. We are unlikely to see better care delivered in the private sector than in the real NHS. Beware the changes, I have yet to see any plan that I have any confidence will deliver me better care as a patient, less expensive care as a taxpayer, more say as a patient, more say as a clinician, more say as a voter or confidence that there will be an NHS in 10 years time.

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  • "The main aims of the health reforms were to make the NHS more accountable to patients and to release frontline staff from excessive bureaucracy and top-down control."
    Yes, that's the Tory party spin, but the health reforms are to remove the NHS from being a provider of care to being a commissioner of care. The underlying Tory ideology is that the NHS should not exist and the state should not interfere in people's lives if people choose to purchase healthcare - recently released papers from the Thatcher years have cemented this point of view.

    Will there be huge change on 1st April? Of course there will not, but a gradual change to 'any qualified provider', which will create the instabilities and break-ups no doubt listed in the Risk Register that we the taxpayer have paid for, but we are not allowed to see! This is called democracy! The very conditions which will cause large pockets of the NHS to fail are being created by the 'nhs is safe in our hands' gvt - and then they will happily point the finger of blame at the local provider - usually NHS provided hospitals. This of course, contrasts sharply with the gvts reaction over poor Serco provision in the South East - where the books were fiddled over 250 times to cover up poor outcomes for patients.

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  • I don't see why we couldn't work on and build up and modernise what we already have. if everybody worked fair surely there would have been money enough to improve infrastructure and all material, human resources, research and training in the latest methods and developing skills and experiences on what was probably a solid and excellent foundation.

    as soon as we bring all the management fangle jangle from America everything seems to crumble and fall apart. we could leave General Management, McDonaldization, etc to the Americans and develop our own models of health and social care more suited to our own culture and needs.

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  • michael stone

    My original post was apparently wrong - either I misunderstood radio 4 early morning, or the report was different by tea-time. Both are possible !

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  • michael stone

    tinkerbell | 3-Jan-2013 5:24 pm

    Not specifically hip replacements, but I've glanced over a paper that suggested that patients who have been fully informed of the outcomes of clinical interventions as compared to no intervention, or less aggressive interventions, often elect for a lower degree of intervention than less-informed patients chose.

    This was mentioned during a long and discursive paper about 'whether doctors are right in thier instincts about the options patients would choose if the patients knew more' (my phrasing), and the conclusion was that doctors are not very good at that (doctors expectations about what the patients would chose, and what fully-informed patients chose, differed).

    I found it on the King's Fund site, but cannot reember what it was called offhand.

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  • michael stone

    Anonymous | 4-Jan-2013 8:33 am

    Tick ! There must be a serious concern that this is an attempt to dismantle the NHS 'by stealth and obfuscation' because I'm 100% with you, about Tory ideology.

    I also agree with

    Anonymous | 4-Jan-2013 8:56 am

    in that it seems that every layer of 'control' to be removed has been replaced with an equivalent one, and it would have been perfectly possible to achieve the STATED AIMS without ripping the old system to pieces (so, again, one looks at possible underlaying objectives).

    I should keep off this theme - it tends to make me even grumpier than usual !

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  • DH Agent - as if ! | 4-Jan-2013 3:00 pm

    don't say you have caught the box ticking tick? I doubt it although you seem to be showing the initial signs. watch out though as it is highly contagious and seems to be spreading fast and during its incubation period, when the damage has already been done, you would not even be aware of it!

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  • tinkerbell

    Anonymous | 4-Jan-2013 8:33 am

    Totally agree, it will be a slow drip, drip that gathers momentum until we all realise finally that we have been well and truly shafted.

    Must go before i swear.

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  • "Fighting back against the Left-wing guerrillas
    Foes of public sector reform are waging war at a local level – they must be roundly beaten

    By Sean Worth
    7:58PM GMT 02 Jan 2013"

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  • michael stone

    Anonymous | 4-Jan-2013 5:40 pm

    I usually can't even remember where the box to tick is !

    But there is an insidious, and invidious, process where 'I've ticked all the boxes' replaces 'I've used my brain, and I feel sure I've made a reasonable job of this'.

    But it is complex, the 'experts and hardly any box-ticking' versus 'non-experts and tick-box guidance' one - I can't really get around the fact that each is the right approach, according to staff expertise level.

    I remember the Goons proving I'd caught something - it was, however, an entirely symptomless disease, but remarkably contagious.

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  • tinkerbell

    the biggest tick box lie

    'I have read the term and conditions'.

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  • you have to read them before accepting them.

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  • michael stone

    In what sense are you using 'have to' ?

    People just tick the 'accept' box as a pretty general rule, and I think you mean that you should read the Terms and Conditions as instructed - most are so complex as to be beyond the average reader, however !

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  • DH Agent - as if ! | 6-Jan-2013 12:22 pm

    it is a legal requirement to read terms and conditions or at least you take legal responsibility if you don't and there is a problem. ignorance is no excuse in the eyes of the law to my knowledge.

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  • tinkerbell

    Anonymous | 6-Jan-2013 1:54 pm

    it's alright i was only ordering a lipstick off

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  • tinkerbell | 6-Jan-2013 9:31 pm

    Anonymous | 6-Jan-2013 1:54 pm

    If you had had an allergic reaction or been poisoned by it and hadn't read the terms and conditions it would be on your head!

    You always have to read the terms and conditions!

    Having said that I wonder how many people do. I tend to skim them to see if there is anything that applies directly to me that I should know but usually get bored after the first few paragraphs. I think they are absolutely over the top and a considerable nuisance and have come to the conclusion if I read all the ones that regularly come through my door it would be an almost full time unpaid job so now I have given them up almost totally which is a risk when one is signing documents. One is legally and or financially responsible for anything that goes wrong if they haven't been read. The problem is too that banks and other companies are always changing them. Then there are others along with instructions which are so minute that even with excellent eyesight would have to be read with a magnifying glass.

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  • “On 1 April patients won’t notice any great difference in the services available and that they receive,” said Professor Black".

    I guess its true to say patients wont notice much difference on 1st April, but they will certainly notice a difference further down the line when more services are privatised and when GP budgets run out before the end of the financial year. GPs are already being paid a bonus for not referring patients to hospital. This is bound to undermine patients trust in their GP.

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