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Cut the fat to improve NHS

29th March 2011

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David Cameron promised before the general election that the NHS would be spared cuts. However, the government have said it that it needs to make £20 billion of savings by 2014. To some this seems to be a broken promise. It is, however, part of a genuine effort to bring much needed financial and structural reform.

It is widely consented that the NHS is hugely inefficient. In the past we have seen Labour governments pump masses of money into it but because of its inherent structural problems, the money just hasn’t reached patients. The Con-Lib government is proposing a restructuring effort that should cut expenditure on bureaucracy and increase expenditure on patient care.

The existing NHS structure relies heavily on Primary Care Trusts (PCTs). These are bureaucratic-administrative bodies that control around 80% of the entire NHS budget. The government is planning to essentially delete this PCT class and give its responsibilities to GPs. Though this will cost £1 billion, it will save a great deal more in the long run in saved wages. The government has predicted that £5 billion will be saved by 2015 in a reduction in staff alone. The money saved from not paying these administrators can therefore be spent more directly on health care.

The argument against this is that GPs will reemploy those former PCT workers to do the same administrative duties. However, GPs have an understanding of what is required in their specific area. They will therefore only need to employ the optimum amount of administrators. This will make the NHS’s administrative capabilities more streamlined, localised and cost-efficient.  

The government is also proposing to put an independent board in the position of highest authority over the NHS instead of the Department of Health. By doing so, the NHS will no longer be able to be used as a political tool as it has in the past.

Previously, politicians have distracted GPs by greatly increasing and decreasing their working hours and salary capabilities. These changes have effected patient care as GPs have been forced to both work fewer and then far greater hours according to the political climate. By giving ultimate authority to an independent board, the NHS will be left alone to do what it does best, help people.

GPs and not bureaucratic administrators understand the needs of patients better than anyone else. By taking responsibility from the administrative bureaucracy and giving it to GPs, the NHS will become more directly responsive to patient’s needs and more efficient.

Some people have warned that the NHS won’t be able to sustain such radical changes. However, it is more irresponsible to keep the current system a float than to change it. Patient care is suffering due to the way in which money is filtered through an expensive bureaucracy rather going directly to those in need. 

Sceptics have also questioned whether it is wise to give large amounts of money to GPs. It is inevitably the case that there is a risk-factor involved in doing so. However, it is important to remember that GPs will be fully accountable to the independent board. It is far better to put money in the hands of GPs who understand their local area than to lose it in a cloud of bureaucracy.

It is also the case that patients should have improved rights in the new system. It has been proposed that practice boundaries will be scrapped, enabling patients to register with whatever GP they choose. These decisions will be based on performance feedback. With the new system, patients’ voices should be heard and acted on sooner because the very people they talk to, GPs, are those who will organise and manage the way in which money is spent in their local area.

In this economically difficult period, it is understandable that people are reticent to support large reform that will mean job cuts and a certain amount of risk. However, we have to remember that the principle aim of the NHS is to give its patients the best possible service. With the new structure, the NHS will have the ability to deliver a better service by saving and therefore reinvesting money. It will also be free from political manipulation and have the capability to empower patients by having their needs heard and met.

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