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Public Services for All > Published by Andrew Georgiou, May 17th 2011 at 11:45 am

Cameron’s NHS reorganisation likely to widen the health funding gap

David Cameron, in a speech at Ealing Hospital yesterday, affirmed his support for Andrew Lansley’s controversial NHS shake up.

In an attempt to shore up support for his government’s ailing NHS reforms David Cameron’s speech sought to explain why change is important for the future of the NHS. What followed, however, were not the words of a man who had taken “time to pause, listen and reflect”. Instead Mr Cameron’s speech neglected to tell the whole story and was almost devoid of any mention of the key issue, competition.

The key plank of Mr Cameron’s address was that his changes were needed in order to save money in the future. He said:

“If we stay as we are, the NHS will need £130 billion a year by 2015 – meaning a potential funding gap of £20bn. The question is, what are we going to do about that.”

He may be asking the right question but he is far from providing the right answer. The truth is that Mr. Cameron’s perilous NHS reforms are going to divert much needed attention away from the key challenge of finding the £15-20bn savings it has been asked for. The King’s Fund rightly points out that:

“Finding the £20 billion in efficiency savings needed to maintain services must be the overriding priority, so the very real risk that the speed and scale of the reforms could destabilise the NHS and undermine care must be actively managed.”

The prime minister may believe that the solution to these funding problems lays in his reform, however the Department of Health disagree. They assert that the funding challenges will “present a significant challenge to the NHS regardless of the structure of the health system”.

So rather than helping to close the £20bn funding gap the government’s misadventure with NHS reform will most likely widen it.

The prime minister also claims that his reforms will see the end of postcode lotteries. However his vision of “an NHS with consistent, high quality care for all – instead of just pockets of excellence” will not be fulfilled under these proposals.

It was just two months ago that the NHS Confederation stated that the government’s plans would worsen the postcode lottery and will mean more variability of access to services. Is the prime minister really saying that he knows more about the NHS than the professionals?

In fact most of Mr Cameron’s harshest critics have been healthcare professionals themselves and Clare Gerada (Chair of the Royal College of General Practitioners), who represents 42,000, GPs believes “that if this Bill is enacted as it currently is that it will cause irreparable damage to the core values of the NHS”.

Mr Cameron’s speech may have been a little sloppy on the detail but it was his silence on the most important part of these reforms that was worrying. David Cameron clocked up twelve pages and almost 4,000 words but only mentioned the issue of competition once. If he intends to ram these reforms through parliament it is this issue that needs addressing the most.

This speech was another demonstration that the government are intent on ignoring all professional evidence and continuing to press ahead unabated. Someone needs to tell the prime minister if he wasn’t talking so much it would be easier to hear what people are saying.

http://twitter.com/isdancing/status/70440157500801024 Mabel Horrocks

RT @leftfootfwd: Cameron's NHS reorganisation likely to widen health funding gap: http://bit.ly/j4snl6 writes Andrew Georgiou
http://twitter.com/paulstpancras/status/70441041899167744 paulstpancras

RT @leftfootfwd: Cameron's NHS reorganisation likely to widen health funding gap: http://bit.ly/j4snl6 writes Andrew Georgiou
http://twitter.com/drkmj/status/70442661777113088 DrKMJ

RT @leftfootfwd: Cameron's NHS reorganisation likely to widen health funding gap: http://bit.ly/j4snl6 writes Andrew Georgiou
http://twitter.com/double_karma/status/70447751711817728 Double.Karma

RT @leftfootfwd: Cameron's NHS reorganisation likely to widen health funding gap: http://bit.ly/j4snl6 writes Andrew Georgiou
http://twitter.com/healthtipsblog/status/70462739591602176 Health Care

Cameron's NHS reorganisation likely to widen health funding gap …: Andrew Georgiou gives a critical analysis … http://bit.ly/jjdXuk
http://twitter.com/shop6vega/status/70462737444126721 Dana Iyer

Cameron's NHS reorganisation likely to widen health funding gap … http://bit.ly/jjdXuk
http://twitter.com/therightarticle/status/70464831924346880 Michael

Cameron’s NHS reorganisation likely to widen the health funding gap I Left Foot Forward – http://j.mp/mQc0RM
http://twitter.com/nhsspy/status/70471222923771904 Watching You

RT @TheRightArticle: Cameron’s NHS reorganisation likely to widen the health funding gap I Left Foot Forward – http://j.mp/mQc0RM
Anon E Mouse

The NHS in this country is an absolute shambles with more managers employed than frontline healthcare workers and PFI hospitals that will need to be paid by our children’s children.

I’ve yet to find a single person who isn’t aware of some screw up by this bloated dinosaur and the sooner the government ignore the Labour doom merchants over the NHS the better.

When people go into a hospital and come out with MRSA, or the elderly are not cared for and left starving and thirsty then something needs to be done.

For Labour to want to continue this fiasco speaks volumes….
George McLean

@1 Anon E Mouse

= “Something must be done. David Cameron has thought of something. So we must do it.”

Your post doesn’t add anything to the debate.

And what is your source for your claim that there are “more managers employed than frontline healthcare workers”? We need to see who you put in each pool. Your definitions may be dodgy.
Anon E Mouse

George McLean – Cameron is running the government and it’s his shout. If Labour had been more popular they may still be in charge. But they’re not and remember ID Cards? Labour wouldn’t back down over that so why should the government not change the NHS?

Speaking from personal experience of my missus being treated privately and my business partner on the NHS the difference is stark.

Here is a link from The Guardian regarding manager recruitment:

http://www.guardian.co.uk/society/2010/mar/25/nhs-management-numbers-frontline-staff

Anyway you haven’t even commented about the elderly not being cared for or the dirty stinking hospitals we are paying for. For Labour to want to continue this fiasco speaks volumes….
George McLean

@1 and 3 Anon E Mouse

The King’s Fund say that figures for 2009 are doctors + nurses + ambulance staff total 485,904 and managers/senior managers total 42,509 out of total NHS staff of 1,177,056. So, there aren’t “more managers employed than frontline healthcare staff”, at least on this staffing definition. Maybe yours is wildly different. Your figures on differential recruitment rates don’t say anything about totals.

On your other points: I haven’t said the government shouldn’t change the NHS. Shirley Williams in yesterday’s Grauniad had some very positive ideas, but ones that she realised needed to be agreed with staff and patient groups, a very different position from that of Mr Lansley. And in respect of your partner’s positive experience of private medicine, well done her! What a good job the rest of us don’t have to fall back on privatised medicine (for which the NHS picks up the pieces and trains the staff).
P Spence

Cameron and Co are clear about what they are doing and are cynically diverting attention away from the core change they want which is to use competition to dis-establish and break up the NHS as a unified and democratically accountable public service. They have no mandate for such radical change which should be viewed as a reactionary step backwards, driven by dogma and disdain for State provision of any sort. Cameron by dissembling so, further risks aggravating the dire public mood towards politicians.
Anon E Mouse

P Spence – My business partner has a disease in both her shoulder bones. After a wait of nearly three years an operation on the left one on the NHS was performed and the results are 100% positive. It’s good.

On seeing the specialist last week and enquiring when her other shoulder could be done, she now has to restart from the beginning with the X-Rays and physio and the consultation. It’s bonkers.

If there was a choice of provider within the NHS another company would simply say they’d do it immediately because as the specialist said that’s all that needs to be done but his hands are tied.

If she wasn’t so left wing she’d pay for it and the same specialist would do it in another ward in the same hospital.

The system stinks and whilst I agree about the dire public mood towards politicians – remember Gordon Brown was the least popular Prime Minister in history, Cameron the most popular of the three party leaders – I just think this government should get on with it and be damned.

Sitting still whilst patients are left wallowing in filth in NHS hospitals is not an option…
Anon E Mouse

George McLean – My mistake sorry. I meant the increases as a percentage – management was up 84% in a decade (using your year, 1999, as the datum):

There are 375,500 qualified nurses – up 7,080 (1.9 per cent) on 2008 and a quarter higher than in 1999.
There are 44,660 managers – up 4,750 (11.9 per cent) on 2008 and 84 per cent higher than a decade before.

Still don’t know why you won’t discuss the dirty wards…
Andrew Georgiou

You are “Yet to find a single person who isn’t aware of some screw up”. However according to polling satisfaction with the NHS is higher than ever (http://bbc.in/hsxtYB). It appears that generally people are happy with NHS.

In response to the “Labour Doom merchants” – It is not just the Labour Party who is objecting. In fact the article’s sources are the King’s Fund, The Royal College of General Practitioners, NHS Confederation and even the Department of Health. There are plenty more independent groups which have strong objections to these changes.

Not to be nit-picky but the article doesn’t actually say that there are more managers than doctors. It says that the number of managers rose faster than the number of doctors over the stated year. The article also includes a quote from the NHS Confederation reiterating the need for good quality management – after all I want my doctor to be a doctor and not a businessman.

Indeed Cameron is running the government but his mandate stems from the winning of a General Election. He didn’t. Instead we have a coalition and in their Programme for Government they stated ‘We will stop the top-down reorganisations of the NHS that have got in the way of patient care’. I see that assurance didn’t last long…….
http://twitter.com/fusr/status/70515777811386368 Tony Hardwick

RT @leftfootfwd: Cameron's NHS reorganisation likely to widen health funding gap: http://bit.ly/j4snl6 writes Andrew Georgiou
Andrew Georgiou

Anon E Mouse lets discuss dirty wards – provide me with the evidence you’re relying on.

I just had a quick look at the Patient Environment Action Team Report for 2010 (charged with reviewing cleanliness among other things) and I think it demonstrates that your claims are wrong. Actually it reinforces the point that NHS hospitals are cleaner than private ones…..
George McLean

@7 Anon E Mouse

I haven’t discussed dirty wards because I thought we were discussing your incorrect ratio on “frontline staff” to “management”. I refer you to the answer from Andrew Georgiou @ 9, and to the fact that wards are now cleaned (or not) by private outsourced companies with appalling management and terms & conditions.
http://twitter.com/russellmayne/status/70604047001989120 Russell Mayne

RT @leftfootfwd: Cameron's NHS reorganisation likely to widen health funding gap: http://bit.ly/j4snl6 writes Andrew Georgiou
mr. Sensible

Mr Mouse, since we’re talking about management, 1 thing I think this government will learn is that, just because you scrap the managers the paperwork doesn’t go away.

They’re finding that out with the police; I read that Warwickshire police is putting officers in to civilian posts, and they’re planning for GPs to be responsible for paperwork rather than treating patients.

At a time when the NHS is having to save £20 billion, the last thing it needs is the biggest reorganization in its history (contrary to the Coalition agreement).

I think a better and less disruptive idea would be to retain the existing PCTs, but have seats on them reserved for GPs, hospital doctors and nurses, and perhaps representatives from local government, like the police and fire authorities, to retain accountability.

This so called listening exercise will be judged on outcomes, and the government will be judged on amendments, not words.