I haven’t read the Health and Social Care Bill. I have glanced at it. I tried to look at anything connected with Mental Health and Social Care and there are a few bits and pieces nestled in there towards the end but the problem with reading primary legislation is that, well, it has a language all of it’s own and it isn’t a particularly easy read compared to White or Green Papers.
That’s my excuse out of the way.
I have, instead, read through some of the commentary about the Bill. I retain all my reservations. In fact, I have some increased ones about the role that the private sector is set to have in the healthcare ‘business’. I find it hard to comprehend how much of a dissonance from Cameron’s mealy-mouthed words about protecting the NHS through the election campaign and the Coalition Document’s promise of ‘No top-down reorganisation’ of the NHS.
Ah, say those whispering Tories, this is not ‘top-down’, this is ‘bottom-up’ reorganisation. So what, exactly, is the government imposing new systems and yet another reorganisation – if not ‘top down’.
I’m no great fan of much that the last government did so I can’t say Labour would be any better. It just feels so hopeless to cry into the night sometimes.
On a local level, we are losing beds and losing wards. That isn’t a far off fiction. That’s happening today. They probably haven’t been noticed because they are psychiatric wards and hospitals rather than cancer or paediatric beds but remember we were there to warn you.. sigh.. I wish it didn’t have to be that way.
Back to the Bill then
The Guardian has a good summary of the main points. Apart from the abolition of the PCT and the move to GP-led consortia bidding for services, there are to be a few regulatory quangos. One, Monitor, which currently.. um.. monitors Foundation Trusts will be beefed up as all Hospital Trusts will have to become independent Foundation Trusts.
Strange then that Monitor is one of the few health bodies that comes out in favour of the Bill. Their almost smug press release saying
Monitor strongly supports the Government’s proposals to move to a more devolved system for the NHS, with increased competition in healthcare, as set out in the Health and Social Care Bill…
In Monitor’s view, introducing more competition into healthcare is an important step in raising the productivity of the sector and delivering ever higher quality care for patients…
It has delivered significant benefits in other sectors and has been shown to improve quality within healthcare and other sectors under the right circumstances.
In particular we welcome the Government’s intention that we will become the economic regulator for health and adult social care.
I’m sure they do welcome the fact that they will be one of the few quangos to be beefed up. It does seem more than a little self-serving as a statement though. I worry that social care regulation has been bundled in to an extent. It’s always going to be clear where the priority lies (clue – it won’t be with social care when it competes to time, money and resources against health).
There is mention of the setting up of a body called HealthWatch which is supposedly some kind of ‘patient voice’. It’s reported to be some kind of ‘consumer champion’ service within the CQC. Well, that discredits it for a start as the CQC seems to be barely fit for purpose and working on less than acceptable staff ratios to keep the public safe.
My concerns remain about the process of commissioning, the welcoming of competition into a market that is not neutral and cost should not be the base denominator of best.
The process of change is tiring. I am no great fan of over-management but I can’t see how a public castigation of the higher echelons of an organisation makes it easier to stomach the change. Change does need to be managed, after all.
We, right at the very bottom of the tier, way below the GP commissioners, will be expected to carry out a better job with less time. I do wonder what will happen to us in secondary health care services. Will we be ‘value for money’?
How will our value be determined? On how much money we save the Trust by ‘keeping people out of now, non-existent hospital beds’?
A few points that I did pick up were that some of the tasks delegated to PCTs currently will be shifted to already pushed local authorities. There are some increased responsibilities for public health and more specifically to my interests, the provision of the IMHA (Independent Mental Health Advocates). I see that local authorities will take responsibility for s117 aftercare services. A tiny line in the Act but potentially a MASSIVE increase in cost. Wow. That’s going to have some implications for the budgets of some care services. Particularly where I work in older adults services.
(N.B s117 of the Mental Health Act 1983 (as amended 2007) compels PCTs (soon to be local authorities) to pay for care for the patient in the community following an detention in hospital under Section 3 of the Mental Health Act. In Older adults services, that can (not always) mean nursing and residential care. Where someone has dementia, they don’t ‘get better’ so the s117 funding remains in place indeterminately. So basically, it means that there will be a lot of funding consideration for the local authorities to pick up and it could mean a lot of care home fees for which no payment can be taken from the families).
The Bill also confirms the demise of the GSCC (General Social Care Council – which registers and regulates social workers in England) and authorises the HPC (Health Professions Council) to be renamed Health and Care Professions Council and to carry out the similar role. I remain basically ambivalent about this until I have reason to believe it may be better or worse than what we have at the moment.
Here’s what I think about the future. And it’s pretty bleak so you might want to look away now.
Private companies like Care UK – you know, the company that made a donation to Andrew Lansley’s private office – will run some of these GP consortia. It won’t be my GP making any choices. It certainly won’t be me making any choices. Cameron’s talk about choice is a red herring in my view.
The talk about choice in the Putting People First and personalisation agenda has been more or less a complete whitewash. Some people get A LOT more choice – those with capacity, those who are able, those with carers able to article what they want, but for the majority of people I work with, that vestige of choice is an illusion. They are getting the same carers, for the same cost carrying out the same tasks with more paperwork and higher criteria for accessing services.
So will be choice in the health service. Articulate and active participants, the ‘worried well’ and those who are able to shout loudest, will have the most choice.
The choice for those who have acute illness will always be limited. Do I trust my GP to make the best decisions for me? Not particularly. I live in an area where there are likely to be lots of involved interest groups with far louder voices.
Will my team be ‘competing’ with private companies able to specialise in managing some of the ‘more straightforward’ situations that we might deal with? Probably. I can certainly see adult care management services devolving now – indeed, that is already happening.
Will it make for better services? Possibly – and I say that with a heavy heart – for some people. The problem will lie with those that the private companies don’t want to ‘hive off’. They will have little choice and with the resources being pushed into reducing cost, possibly fewer resources.
I see this as a blueprint to increase health inequality and social inequality in England.
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I’m not joking when I write this but I am considering moving to Scotland where at least I have family links. I wonder how easy it would be to pick up the Scottish legislation and switch my English registration for a Scottish one.. seriously, if anyone does know the answer to that, let me know!
Related Articles
- Health and social care bill: the main points (guardian.co.uk)
- NHS reform proposals under fire (mirror.co.uk)
- Changes in the NHS – initial thoughts (fightingmonsters.wordpress.com)
- Bill to detail major NHS overhaul (bbc.co.uk)
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Scotland – i had the same thought!
i work in a rural area in adult mental health at present we have one picu and four small local community psychiatric units spread round the county,news is they are closing three of he smaller units which will loose us about 40 beds and means if people do need to go into hospital then they will be taken out of their local area and plonked miles away from family,friends and everything hey now – it takes about 1 hour 45 minutes to get from one part of the locality to the place where this unit will be- how can that be good?
As a social worker in Scotland I have been reading about the proposed changes in England with similar concern to those views already expressed. I wonder what type of health care I would come to expect if I lived in England? The uncertainty encourages me to remain north of the border!
The long term tension, as I have understood it, has been the different level of expenditure in the NHS on whether you need services for acute or chronic health care. This is why there has been so little investment in the cinderella services of psychiatric and elderly health care.
The Scottish Government has being doing some serious analysis on the cost of public services and two commissions are now working to try and come up with new ways to tackle the problems, one commission has been set up by the Government and the other by the Labour Party – who suggested at their recent conference that there should be a National Care Service for Adults, potentially part of the NHS. Suffice it to say that most public money spent on health and social care of the over 80’s is on acute hospital admissions, following falls and heart attacks in the community. Serious time is now being spent in seeing if preventative work in the community could reduce this public spending. Results of teh two commissions will be out in the summer.
On the political front there are now some very significent factors driving public policy in social care and health provision. Since 1999 Scotland has had either coalition or minority governments. We have another interesting election for a new government on 5th May and there is no certainty about which direction the dominant lead will come from. With only one Conservative MP from Scotland in Westminster and just a few Conservative MSPs in the Scottish Parliament social policy on Scotland is being driven by combinations of MSPs from SNP, Labour, Lib-Dems, Greens and critical votes held by independents. These various coalitions have encouraged cross-party support for health and social care in tryng to find solutions to difficult problems rather than time consuming adversarial politics. This is why the ten year committment to implementing the 2006 Changing Lives Review has been largely successful in modernising our social work services.
We have many challenges ahead, not least in how public money will be spent, but the climate in which we face these issues does include the voice of social work and our strong professional association, BASW Scotland, will continue to be part of making a difference to people’s lives.
Moving to Scotland is certainly possible, you can change your registration to the SSSC and employers and BASW Scotland will give you help getting to grips with our progressive legislation (which we helped develop – so is easy to read and understand!). If you want more information you will find me at the BASW Scotland office – details on the website!
Welll for me i have two thoughts i think the current system is in a mess it could basicly go good or it could go bad i tihnk we will find out in the following mounths
I’m afraid your antennae are right, cb; this is bad, bad, baaaaaaaaaaad as Kojak used to say.
The basics of the situation are this. For some years, companies like United Health (American), Atos (French) and others have been buying up GP practices. Richard Branson has also moved into this via Assura, which is one of the biggest owners of GP practices in England. This is fairly modest at the mo; about 200 practices are owned by the big boys. It’s not going to stay like that. Now, the budget for the NHS is going to be handed, not to GPs, but to GP practices to commission secondary care, mental health, elderly care services etc. In those areas where the big boys are in control, you’re handing it straight to them. In those areas where they don’t yet operate, there’s no way that ordinary GPs have the time or experience to run their own GP practice and health commissioning for the entire area they’re in. So they will get someone else to do it for them. Guess what United Health and Serco specialise in. Yep , health commissioning. So they will come into play in the areas they don’t already operate in.
It doesn’t end there. Some of these companies have other interests. Serco for example runs facilities management at Leicester and Norfolk and Norwich Hospitals; it also runs out- of -hours GP services in Cornwall. Circle run a chain of private hospitals; it has also recently taken over Hinchingbrooke hospital, a former NHS hospital. So if they also take over commissioning, they will end up as both purchaser and provider of healthcare services. And this bill also removes the cap on the number of private patients allowed at NHS hospitals, so it’s going to turn into a free-for-all. NICE has just been divested of its powers as regulator of prescription drugs, so no doubt a few pharmaceutical companies will also get in tow with this in return for a few wads of cash in the right pockets.
It’s a total utter nightmare. Labour paved the way for this and the Conservatives are trying to finish it off. Unless the Lib Dems grow a spine soon, this is the nuclear button for the NHS and I fear virtually the end for your speciality cb. It is different here in Scotland; we didn’t allow private companies to take over GP practices here and we passed legislation in Holyrood to reinforce that, but that may not be enough. If it’s any consolation, we are doing our best to help our counterparts south of the border on this, because if it gets passed in England, it’ll probably be only a matter of time before it reaches here.
Sorry to be so gloomy, but you need to know and spread the word. It’s time to take a stand.
Thanks for all the comments – Ruth, I may very well be in touch!
agree with all you say but when looking at the bill and i agree a hard read even for a bill of this size sec 117 obligations will continue to be shared between LA’s and instead of PCT’s Gp consortia
Thanks, I’ll have to check that 🙂