Britain Loves the NHS

And the NHS loves an acronym.

Britain's political classes are still tying themselves up in knots over the reforms to the National Health Service (NHS) brought about by the Health and Social Care Bill 2011. Politically what's going on here is really simple. However to get that far you need to know about health care provision in the UK which really isn't. So the short version;

The formation of the NHS in the late 1940's placed a legal obligation on the British government to provide health care. For the next 40 years this obligation was met at the local level through Local Health Authority's (LHA's) which are just another form of local government. In an effort to privatise the NHS in the 1980's Margret Thatcher's Conservative government introduced the Primary Care Trust (PCT). Legally PCT's are quite unique and therefore quite hard to explain. However they're basically a not for profit corporation with their own leadership that is separate from the LHA but is funded through an annual grant from the LHA. In return for that grant the PCT provides the LHA with Primary Care Services (PCS') such as emergency medicine, maternity services, phlebotomy services, nursing services, surgical services etc along with all the bureaucracy such as admin, building management and cleaning services needed to support those services. The government's obligation to provide Secondary Care Services (SCS') such as dentistry, elderly care, ophthalmology etc was all but removed and these services were placed entirely in the private sector. However under something known as the Internal Market a PCT couldn't simply provide PCS'. Instead they had to break them down into as many constituent parts as possible. So a simple hip replacement surgery became a joint operation between the anesthesia department, the orthopedic surgery department, the nursing department, the beds department, the laundry department, the catering department and so on. In order to get the operation done all these different departments had to buy their services off each other using pretend money. Needless to say when Tony Blair's Labour government took power in 1997 the NHS was close to collapse with record numbers of people taking refuge in private health care.

The 2011 Health and Social Care Bill will completely remove the legal obligation on the government to provide health care and will replace the PCT system with a much more complex system based on consortia of General Practitioner (GP) practices. GP practices are and have always been private small business partnerships. However the ones that choose to treat NHS patients are regulated by the LHA, paid per patient and simply transfer any patient that needs PCS' that the GP can't provide over to the PCT. Under the new system GP practices will group together and buy the treatment their patients need from other private providers using individual NHS patient budgets. NHS hospitals will more or less still exist for now but they will have to compete for business from the GP's like any other provider.

Initially the GP's took this to mean that if their patient needed pharmacy services they could send them to their brother's pharmacy business and if their patient needed physiotherapy services they could send them to that private physiotherapy clinic they half own and the taxpayer would pick up the bill. Eventually though the doctors realised that European Union (EU) and World Trade Organisation (WTO) competition rules mean that the big boys such as Circle Healthcare and all the big US providers could also come and play and their small operations don't stand a chance. So now all the doctors are getting their alumni in the House of Lords to add endless, pointless amendments in the hope that the passage of the bill through Parliament will take so long it will be dropped. A few liberals also found my grandmother's test run through this new system so terrifying that they're also trying to add a couple of amendments themselves.

None of this will come to anything though because as my grandmother's case demonstrates the new system is already in operation in much of England and Wales. Also a High Court test case in autumn 2011 ruled that the new system is how health care has to be provided regardless of whether or not the bill is passed. All this Parliamentary posturing is simply there to try and convince people that Britain is a democracy and draw confused attention to the nation ahead of the 2012 Olympics.



Edited at around 20:05 on 28/2/12 to add;

It's Tuesday February 28th and I'm back from the pub. It was quite pleasant. I had the beefburger but spent most the time worrying about whether or not my use of the word "alumni" in the above post is the correct word to describe the complex relationship I was trying to explain. Along with banking, law and the sciences in Britain medicine is considered one of the old professions. So in order to get ahead as a doctor you really need to be a member of a Royal College such as the Royal College of Surgeons and from there Knighthoods and Peerages will surely follow. It is these assorted colleges that are exerting pressure on the House of Lords to block the Health and Social Care Bill 2011. So I suppose one of the other main themes of the play is the friction between Britain's old guard and the modern world.