Healthcare needs radical reform – but Cameron must brace for the backlash

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The new government’s policy on public services was launched yesterday by the Prime Minister, with an uncompromising statement of NHS reform. He pledged more competition, including in the private sector. He promised wholesale changes in the delivery of services, so that GPs, hospitals and other services work together and prevent ill health in the first place. In the last Parliament, some argued that the NHS should be excused from the drive for efficiency. Yesterday, David Cameron rejected that view unequivocally. As he put it: “the NHS must step up. There is no choice between efficiency savings and quality of care”.
 
Cameron set out this vision under the banner of a much-needed seven-day NHS. The largest number of critically ill patients turn up to hospitals at the weekend, just when services are least able to handle them. There are fewer medical consultants on call and operating theatres are out of action. The result can be catastrophic for patients, and costly for the NHS. Expensive equipment and facilities lie unused for two days each week. Mortality rates for patients admitted to hospital on a Sunday can be 16 per cent higher than for those admitted on a Wednesday. Demand for treatment is inefficiently bunched on Mondays – much to patient frustration. Many in the NHS are warning that seven-day care would mean additional costs for hospitals; with the sector forecasting a £2bn deficit this year, any extra expense is a cause for concern. Hospitals will, therefore, need to use staff and services in very different ways. Local services, such as A&E and maternity units, will need to close or merge, emotive as this may be.
 
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For many of the 1.3m members of the NHS workforce, Cameron’s speech means new scrutiny of their traditional roles and relatively generous terms and conditions. The Department of Health and others have already made clear that in a seven-day NHS, generous “anti-social hours” payments can no longer be afforded. The backlash has already begun, with the Royal College of Nursing yesterday threatening strike action. 
 
In the end, any successful health reform means big changes for NHS employees, whose terms, conditions and attitudes determine what the service can achieve. For that reason, every recent government has ended up having a major row with some of the representative bodies of NHS workers over plans for change. This Parliament will be no different.  
 
As important for many patients will be the Prime Minister’s pledge of weekend and evening access to GPs. This was a Conservative manifesto pledge not just at this election but in 2010 as well – yet little progress was made. Making good on this promise the second time around will mean more than just pledging access targets, or more GPs when they are already in short supply. It will mean exciting new ways of delivering primary care in new places, and sometimes by new providers. NHS chief executive Simon Stevens has pointed to “virtual” primary care as an alternative to lengthy waits and inconvenient opening hours. Yet while the vast majority of the public has the internet, and growing numbers interact remotely with services such as banking, only 3 per cent of Londoners book GP appointments online.
 
Meanwhile, the private sector is going straight to the consumer to offer services not yet provided by the NHS. An app called Babylon allows patients to skype a doctor through their smartphone, for example. Patients can order prescriptions online, to be delivered to their front door, via DrThom. Encouraging alternative providers from outside the NHS could spread these kinds of innovations and improve access through better services, not just more GPs. 
 
This bold statement of reform was a challenge to the health service. Before the Prime Minister spoke, an alliance of NHS leaders wrote to a newspaper saying that the pressures on the service needed much more money, including an immediate cash injection. A similar group made the same claim three weeks ago – on that occasion, it included the former head of the NHS, Sir David Nicholson. It is a sign that the government’s reform programme is not, and won’t be, welcomed by all. The Prime Minister will need to be as resolute on NHS reform as Theresa May was on police reform last Parliament, if he is to weather the storm.