- It allows private providers to cherry pick what services it provides leaving NHS to pick up the problem patients which don't present an easy profit (the Lib Dems have claimed they have amended the bill to prevent this happening but their amendment only demands that providers are transparent when they do cherry pick).
- It forces hospitals to compete against each other for funding meaning that they are at threat of unplanned closure if they don't get enough patients. It also promotes competition rather than integration of care which is what is needed to help better manage the prevention of long-term conditions such as diabetes and liver disease, two illnesses that are rising exponentially and are a massive drain on NHS resources.
- It allows up to 49% of work at NHS hospitals to be given over to private patients effectively doubling the waiting list for those people who can't afford private health insurance.
- The risk register, that the Government refused to release despite repeated demands to do so from the Information Commission, was leaked yesterday. It is thought to be an early draft but it clearly warns that the Bill could make the NHS unaffordable: "[A risk that ] design work proceeds without the confirmation of cost envelopes for each organisation which means that the future system design is signed off, and the Bill proceeds, without assurance that the whole system is affordable. One example of area where system could be more costly is if GP Consortia makes use of private sector organisations/staff which adds costs to the overall system". The document continues:: "[A risk that] Future efficiencies cannot be managed and driven through the system effectively, because there is no organisation to plan and manage holistic efficiency programmes. So there is a risk that costs of the future system cannot be controlled."
So what are my predictions?
- In the short-term there will be a vacumn of authority as the old system devolves power to GPs who are learning on the job. I predict there will be a flurry of contracts awarded to private companies to take control of local commissioning and health services as GPs struggle with the enormity of the challenge imposed upon them
- In the medium-term integration between departments and hospitals will begin to splinter as hospitals concentrate on pulling punters into their doors in order to 'win' funding from GPs. (For example from my own experience Chelsea & Westminster hospital send their doctors to Brompton hospital to enable joint consultation for CF patients who also have liver disease. I can imagine such arrangements ending due to funding complications.)
Waiting lists will rise as services try to stick to budgets by rationing care
More and more obese people and smokers will find themselves denied services as GPs find any excuse to limit care in order to meet spiralling costs.
National scandals will arise in which private health companies are accussed of patient neglect and care as they cut services in order to make a profit. This has already happened under Bupa.
- In the longer-term, we'll all get used to paying for some NHS services. I can easily imagine paying for evening and weekend doctors appointments as it'll be billed that you are buying the convenience of the time, not the service.
It'll become routine to take private healthcare if you can afford it.
- In the very long-term the NHS will become a safety net only for those who have no private healthcare, and people will expect only the most basic care for it.
As such the life expectancy gap between the rich and poor will continue to widen.