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Asian Voice Column - 1 October 2010



By Navin Shah AM 



The coalition government’s white paper Equity and excellence - Liberating the NHS’

published in July on alleged ‘health reform’ proposes the biggest shake up of the NHS London with its proposal to abolish the strategic health authority and London’s 32 primary care trusts.

Like many of the coalition government proposals this is yet another half baked initiative. The radical shake up was not in the Tory manifesto and the flagship concept of GP Consortia replacing PCT is a crude attempt to privatise NHS through the backdoor. At a recent consultation meeting in Brent one of the panel members suggested that eventually GP consortia may look like PCT in years to come! How true. Surely the proposals are about replacing public quangos (PCT) by privatised quangos (GP consortia). If I had to choose between the two I’d opt for PCTs with a good level of accountability than the privatised commercial GP Consortia, controlling public funds worth billions,   driven by commercial interests rather than patient care and accountability. The Financial Times commenting on the proposal said ‘The HHS faces its most radical shift of power and accountability and the largest structural upheaval in its 60 year history.’

Health and Public Services Committee of the London Assembly conducted a discussion with Ruth Carnell Chief Exec NHS London on the white paper with a focus on its impact on London.  Key aims of the meeting were how NHS London will be affected by changes  - with a particular attention on

  • Reconfiguration of community and acute services
  • Changes to commissioning and management structures (GP Consorita)
  • Achieving efficiency savings
  • Londonwide working and potential role of the GLA / Mayor.

In summary the discussion highlighted

  • The changes would affect every part of the system.
  • Given the changes how do we hang on to a significant level of improvements / achievements made in London when 54% reduction in management cost is sought through financial controls. Is this practically possible without affecting patient care?
  • With the abolition of NHS London where will the current functions go?
  • Ms Carnell expressed strong views about impact / issues related to London.

-          The strategic importance of London, the leadership it provides and significant role London plays that needs protection.

-          Research and development including training. 

-          Wide range of special services and expertise London provides which require protecting.

-          Unique diversity related health issues in London.

Mayor’s Role:

-          Extended scrutiny role.

-          Issues related to public health and Councils responsibilities. How will this fit in with Mayor’s strategic role.

-          How will local Councils work with GP Consortia?

-          Should the current status of London Ambulance Service remain unaltered?

GP Consortia:

-          Current PCTs to provide active support.

-          Accountability: Proposals for National Commissioning Board but no mention of regional monitoring regime.

-          What are the risks and how big Consortia should be? If small: they’ll require support services from elsewhere. If big inherent problems of bureaucracy.

-          How the transition will from PCT to GP commissioning will work and how much will it cost to implement the change.

NHS Finances:

-   Concerns expressed by London Assembly Members as to how PCTs and NHS         would produce major management cost savings and at the same time oversee the structural changes proposed in the white paper.

I remain wholly unconvinced about the white paper proposals and I support the legal action by Unison against the Secretary of State for Health, challenging his refusal to consult the public on proposals in his White Paper.  The union has argued that no steps should be taken to implement the changes in any way, until the public have had the opportunity to consider and comment on them.