Category Archives: NHS

Applying the four tests to NHS reform…really?

Happy New Year (almost). Here’s an interesting one to be filed in the ‘NHS reform challenges’ folder…

In a recent article from GP online, we see more issue arising in the GP-led NHS conversations. First it was that there was – and is – concern as to whether GPs would have the expertise and desire to commission services. Next came the privitisation concerns. Then the centralisation/decentralisation of services concerns.  Meh, perhaps they all came about at the same time.

Anywho, it seems that Health Secretary Andrew Lansley ‘this week backed plans to centralise specialist maternity services across hospitals in Kent, with Maidstone Hospital set to lose its consultant-led service’ – even though 90% of local GPs were against it (according to a BMA poll).

There are four tests that must be applied prior to any significant reform. Any reform must:

  • Have the support of GP commissioners
  • Fully involve the public (consultation and engagement)
  • Be underpinned by clear clinical evidence
  • Consider and support patient choice. That is, ‘no decision about me, without me’ (the new mantra since the release of the White Paper).

Wow. The four tests open the floodgates for interpretation. Whilst clinical evidence is rather definitively hard-and-fast, the others are so…squishy.

Significant change

What is the definition of ‘significant change’? Isn’t that a bit subjective? Some changes greatly affect certain populations whilst others may not give a lick. I mean, I may not be concerned right now with cancer services and how they’re delivered. However, should I ever find myself a service user (knock wood), you can bet your bippie I’d have an opinion.

What’s the threshold for involving the public? Is it to include a percentage of service users in a particular area? Receive a discrete number of responses? A guesstimate of sentiment? Is engagement achieved online? Through in-person events and meetings? All of the above? Maybe that’s a toolkit that should be created.

GP support

Similarly, I find ‘support’ such a nebulous term. If we take the above 90% of GPs that are against the specialist maternity centralisation as an example, we could (incorrectly, of course) assume that the remaining 10% favour the change. Does 10% constitute support?

Health minister Anne Milton has already advised that if the changes don’t meet needs, GP commissioners can seek to redesign and commission services. Sigh. Instead of constantly changing services through centralisation/decentralisation and back again, perhaps we should first design the most efficient service for an area and keep it intact for enough time to improve and truly measure the outcomes. Take the London stroke model which is already providing real results. It took a step-by-step approach to create an integrated system that would achieve maximum ROI. Patients, the public and clinicians were all involved in the design. Implementation was phased in to ensure all sites were ready with specialised staff and facilities.  Bing, bang, boom.

Patient choice

I’ve not had personal experience with the NHS and patient choice. In the very few times I’ve visited a doctor here, I’ve simply gone to my neighbourhood GP. However, if you’re a soon-to-be mom, you may well have a strong preference in specialised maternity services.

In an ideal world, we’d all be free to use any service we wished, without geographic boundaries, and would be assured of the same high-quality, cost-efficient care.

Oh, if only. Perhaps that’s my wish for the New Year…