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PT and the Greater Good

PT Input into the NHS Changes

Published December 28, 2010 4:03 PM by Dean Metz

My blog is a simple one this week. This is the Chartered Society of Physiotherapy's response to the proposed NHS Changes. Number 8 reminds me of the plan the APTA has for vision 2020.

Summary of CSP response:

1. The White Paper proposals represent a high-risk strategy. CSP has grave concerns about the scope and speed of the structural changes proposed and the resulting major risks to patient care. We are also deeply concerned that the proposed shift to GP-consortia-led commissioning and plurality of providers may fragment patient care, create a "postcode lottery," increase health inequalities and costs. We urge the government to reconsider its approach.

2. The current pressure on the Health Service to make substantial efficiency savings will inevitably impact its ability to introduce what could be the biggest organizational change it has experienced, since its inception in 1948, at the same time.

3. The NHS is currently, in many areas, providing a good service, with positive elements that should not be put at risk.

4. The White Paper poses threats to the rights of NHS staff to their national pay, terms and conditions and pensions. There is well-established research linking quality employment to quality care, which supports CSP's view that changes to these employment rights will have implications for the quality of patient care in the future.

5. We urge the government to put these proposals to full public consultation and to slow down the timeframe for the proposed changes to allow pilot schemes to be carried out to ensure the fundamental principles are right.

6. Commissioning of health care is an immensely complex activity. It requires a wide range of clinical expertise and highly robust data.

7. Some areas of the existing system have been slow to embrace this complexity and achieve high standards but that does not imply failure of the system or the need for radical change.

8. There is a lack of evidence that the proposed system will provide improvement.

9. There are considerable concerns that effective workforce planning, including education for professions, will be further damaged by the proposals.

10. The timescale for implementation and the financial stakes are monumental challenges.

11. GP consortia will require considerable input from a number of clinical professional groups if they are fully to grasp the breadth of issues of service provision.

12. There is no evidence that increased competition will increase quality or innovation in health care delivery and our concern is that the proposals will have the opposite effect.

13. The current proposals provide no reassurance that there will be more robust attention paid to clinical quality or workforce standards in the plural provider system.

14. The rapid removal of all the mechanisms to manage or influence the NHS's expenditure of £110 billion to be replaced by only one regulator, the NHS Commissioning Board, seems to be a major risk of fragmentation and postcode lottery.

15. Consortia of General Practitioners may have difficulty in accepting the role to ration health care provision.

16. There is a lack of clarity over how small-scale and highly specialized clinical services will be commissioned.

17. CSP is keen to enter into constructive dialogue and work with the government to seek solutions to address our concerns.

Sounds like the new year is going to be an interesting one! May yours be happy, healthy and prosperous! Cheers!


#4 is a keen observation oft overlooked in businesses.    Employers who can grasp that well compensated (NOT ridiculously compensated) employees make better employees are ahead of the curve.  When compensation packages take care of the employees, the employees are freed to concentrate on their jobs, rather than ancillary concerns - like providing for their families' well being.

#12 exposes an interesting dilemma.  One we find here in the states.  While competition allows excellence to rise to the surface, there can also be a negative result.  A chasm develops between excellent care, acceptable care, and deplorable care.  Which care you receive depends on your financial means.  Competition does not mean everyone gets excellent care/service.  It usually means those who are wealthy get excellent care/service, but there still exists a level of care for the middle and lower classes.

Scary example.  Our insurance told a friend they wouldn't pay for the medicine anymore.  It was going to cost our friends each $250/month.  They have the means to do that.  The husband decided to pay, but his wife didn't think it would be a big deal and switched.  It didn't work.  She switched back, paying the $250, but now that medicine, which worked fine before, no longer works.  She now has multi-system involvement.  All because the insurance didn't want to pay.  Well, they are paying now!  Multiple specialists are involved and one hospitalization so far.  She had the choice.  We wouldn't.  We couldn't afford $500/month for prescriptions.

Competition does NOT mean everyone has access to excellent care.  Often, as the CSP points out, it means just the opposite.

Janey Goude December 30, 2010 7:28 PM

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About this Blog

    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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