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The caring profession – will NHS reforms turn out to be a botched operation?

The caring profession – will NHS reforms turn out to be a botched operation?

🕔09.Nov 2012

The NHS is going through an immense change, not just organisationally but culturally too.

The NHS is forever subject to organisational change at the whim of any new Secretary of State, be they Labour or Conservative, but patients are usually relatively immune from the consequences. I fear this is not the case with the latest change process.

This reconfiguration – overseen by a Conservative ledadministration – creates a bureaucracy that would make communists proud. Andrew Lansley’s idea of freeing frontline clinicians to directly commission health services, with little bureaucracy, has turned out to be quite the opposite.

Although many have tried to get the message out to the general public – that the changes will have a potentially devastating impact on patients – this has not gained much traction. That will not last for long, as patients start to endure longer waiting times, reduced access to health services – and even another major scandal like Mid Staffordshire.

The myriad of organisations responsible for bits of commissioning, together with competition in the provision of services, will result in patients suffering and the most vulnerable falling through the cracks.

I’ll give an example of a service I am working on at present – sexual health services. In the previous regime, PCTs were responsible for all sexual health services.

In the new regime, three different organisations will be responsible for bits of sexual health services: the Local Authority Public Health, Clinical Commissioning Groups and the National Commissioning Board. This surely will lead to confusion and fragmentation, with different providers providing bits of services, all potentially blaming each other, when people fall through the cracks.

I can envisage someone with HIV being forced to go to one provider for basic contraception service and and another for more highly specialised HIV treatment, instead of being able to access both services together under one roof.

It will take strong leadership to ensure the system does not disintegrate into competing silos of highly paid egos.

What does this strong leadership look like? In my opinion, it will require the leaders of the various organisations, to be humble, selfless, open, honest, transparent and above else putting the needs of their patients first.

Are these leadership traits available in the NHS? Only time will tell.

It is imperative that patients and those advocating on behalf of patients keep a close eye on the new system and hold to account its leaders. Patients must not suffer as a result of this of the system on ensuring it is not patients that suffer because of this botched operation that is the Health Act..


Waheed Saleem is a fomer NHS manager, know pottering on the edges.

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