The NHS and our Big Society

“In most circumstances, competition for services increases quality, but the opposite is true for health care”

Amelia Cutts, the fourth year course representative for Medsin Southampton, writes on her concerns over the proposed changes to the NHS.


Over the last couple of months, there has been a lot of discussion of the NHS reforms and the health bill ‘Equity and Excellence: Liberating the NHS’. Country-wide there have been protests and demonstrations as many groups and individuals disagree with the proposals.

Health unions, The Royal Colleges, The King’s Fund, and leading medical journals including the BMJ and the Lancet have already been outspoken in their criticisms of the reforms, and the BMA are set to soon follow suite.

The Equity and Excellence health bill is a long and complex document totalling 57 pages, making it incredibly difficult to read. As a result of this a summary has been produced. The summary however fails to convey some of the larger issues of the reforms. My worry is that it is not just Joe public that reads this summary – most MPs do too, and talking to them offers a revealing insight into how little they actually may know about the proposals.

So, what exactly are the reforms planning?

Patients are to have more choice under the new reforms, with local authorities running the commissioning budget. This sounds good in principle, but local authorities are likely to vary considerably in their service provision, further increasing inequalities around the country. If you’re thinking that this won’t affect you, well, it probably will. There is a possibility that services will be reduced country-wide as a result of competition and choice commissioning from your local authority.

The GP consortia will be responsible for commissioning services that patients will receive. Health Secretary Andrew Lansley has said that the new GP commissioning service should contain health professionals from primary and secondary care, however, this is up to the GPs to decide. From the pilot of the GP pathfinders that have been created, there have been mentions that this is not happening, and that only GPs from primary care are involved in some. There is another issue with GP consortia, and that is that they are meant to be cutting middle-management. With the intense workload that GPs already have, it is likely that they will outsource their commissioning responsibilities to managers from private companies, who will be seeking to make a profit from your health care.

GP consortia will have to consider any willing provider under European Competition Law. In most circumstances, competition for services increases quality, but the opposite is true for health care. If there is competition on price then the quality of care falls. Lansley last week said that he never proposed competition on price, but that of quality of care. Just how this is going to be measured we are unsure, and this rightly raises concerns.

Why are people so angry?

The statistics that have knowingly been used to promote the reforms are either out-dated and have not been looked at thoroughly:

  • The UK spends 7-8% of GDP on healthcare compared to the USA which spends 15%, and yet we have a longer life expectancy and lower child mortality rates.
  • The Commonwealth Fund survey last year found that 92% of adults in the UK were satisfied with the NHS as it is.
  • Very few patients (5%) miss appointments or don’t buy prescriptions because they can’t afford it in the UK, whereas in the USA this is over 30%.
  • The statistics on heart attack deaths used by the government to highlight the failing of the NHS reported that UK heart attack death rates are twice that of France. However, this was an isolated statistic from 2006, and doesn’t show the continuing improving trend since the ‘80s, which is set to overtake France as soon as next year, and has improved faster than anywhere else in Europe.

Ben Goldacre has mentioned these in his “Bad Science” blog, and is also very outspoken about the detrimental effect that the reforms could have on both patients and healthcare professionals.

Big Society NHS

Some medical students and junior doctors around the country are so concerned about this that they have started their own campaign: Big Society NHS. They are working alongside groups such as Save our NHS, Keep our NHS Public and Medsin, a large network of students who are interested in global health issues.

If you are concerned about the governments plan for NHS reforms then visit this website to get involved.