And so we turn full circle. Health care is once again being restored to local regional governance. The announcement today that the £6bn health and social care budget for Greater Manchester will be taken over by regional councils under devolved NHS powers is in one sense good news. Local control will allow more joined up health and social care that is responsive to local needs. But there are concerns and these have been given by he BMA.
The Tories always have a desire to mess about with the organisation of the NHS. They most often do so in the hope that it will save money - that is 'cut' NHS funding. For this reason I am always wary of moves to reorganise health care provision. They fiddle with the deck chairs whilst the ship is allowed to sink, and then give as a reason the sinking of the ship. It runs a bit like this. The ship is sinking so lets reorganise all the deck chairs so that it sinks more slowly. The ship continues to sink and so the deck chairs are moved once again, trying to shift the ballast. This is how it is with NHS reform, when the bottom line is really funding. A well funded NHS is second to none. But it isn't well funded, or at least not well enough.
Yet again it means a reorganisation of a health service still reeling from the impact of the unnecessary reorganisation imposed by the coalition government. The Prime Minister, Mr Cameron, promised no top down reorganisation of he NHS, yet immediately set about imposing confused and ill-judged reforms. He promised the NHS budget would be protected from the austerity cuts, yet £20 bn has been taken out of the NHS budget for England under he guise of 'efficiency savings'. These efficiency savings have left a strain on overworked front-line staff.
Responding to the announcement that the health and social care budget for Greater Manchester will be taken over by regional councils, Dr Mark Porter, BMA council chair, said:
“There is no doubt that patients would benefit from more joined-up health and social care. However, any plans to do so would have to be underpinned by clear funding to ensure that an already dangerously over-stretched NHS budget isn't used to prop up a woefully underfunded social care budget.
“These wide sweeping changes will affect millions of people. We need to look carefully at exactly how they will affect the commissioning and delivery of services, and what the impact on patient care will be. We must also ensure clinicians have a central role in decisions over health care, something which was undermined by the Health and Social Care Act 2012.
“We need assurances on who is responsible if these changes go wrong. Doctors believe the secretary of state for health should have the duty to provide a universal and comprehensive health service, and must take responsibility for guaranteeing national standards in the of quality care across the country, especially if the delivery of care is to be devolved to local authorities.
“The NHS has just undergone unprecedented upheaval, there must be no more games with our health service and we need to avoid a situation where the NHS moves from being a national to a local political football.”
The reform is good in principle, but it must be put into effect with care. It must be made clear who is responsible for ensuring a universal and comprehensive health service across the country and how best this can be achieved.