Conservative Party launches Proposals to
Reform the NHS
26/06/2007

Last week the Conservative Party (www.conservatives.com) launched its proposals to reform the NHS in the form of a white paper entitled 'NHS autonomy and accountability’. A future Tory Government would abolish national targets and hand the day-to-day running of the service to an independent health board. Patients could choose any hospital for their treatment including private ones provided the care was at or below NHS cost. Senior doctors would be in charge of local budgets, but could have their salaries reduced if patient care was poor.

As a practising NHS clinician, these proposals initially appear attractive. I would certainly welcome the abolition of the excessive targets which have distorted clinical priorities. Patient choice would help to drive the system through encouraging improvements in the efficiency of service delivery and an expansion in the number of providers. This in turn should help to shorten waiting times and improve other aspects of patient care. Giving senior doctors control of local budgets would enable funds to be better directed to areas of clinical priority. However the proposals also generate a number of questions:

How would the health board differ from the Department of Health? What would be its relationship with the SHAs and PCTs?

The concept behind national targets linked to hospital ratings and eligibility to become Foundation Trusts has been a good one in terms of providing a 'carrot and stick’ mechanism to drive improvements. Under the new proposals the predominant driving force will be more of a commercial nature in that NHS Foundation Trusts and private sectors providers will be competing for patients in terms of the range and quality of services offered and waiting times for treatments, but these will not necessarily equate to clinical standards. Therefore what mechanisms will be in place to ensure there are minimum national standards of care and what incentives will there be to achieve these?

If senior doctors pay is performance related, will they be represented on the hospital board and in a position to make executive decisions regarding the running of the hospital?

A fuller reading of the White Paper may provide answers to some of these questions and I look forward to the future debate on these proposals.