Will NHS reform bring health care fit for you?

The government has proposed a number of changes to the NHS in England, changing the way we’re all treated. It says that the new system will give patients more choice, but has it made the right prescription?

Yesterday the government published the Health and Social Care Bill – its vision for the NHS.

It’s over 300 pages long, so our health experts will be poring over the detail for some time yet. In the meantime, what do you think about the changes it proposes?

A prescription for the NHS

The Bill is the latest in a number of publications telling us what the government wants our health service to look like. According to the government, ‘no decision about me without me’ will be the guiding light for the future NHS. What does that mean? In short – it promises its reforms will bring a ‘patient-centred NHS’.

Patients will have more choice – about who treats them, what treatment they get and where they have it – and a new body called HealthWatch will protect their interests.

But could too much choice mean no choice at all? I don’t know if people really want to make all these decisions about their healthcare. Do we really want or need all of these options?

One of the biggest changes we’ll see is the way that health services are planned and managed. At the moment, local Primary Care Trusts are responsible for making sure there are enough of the right kinds of health services in local areas. In the future, groups of GPs will instead be responsible for a lot of this work – and they’ll hold the lion’s share of the NHS budget to do it.

Potential side effects

Supporters argue that GPs have expert knowledge of their patients and so know more about the services they need – but not all doctors are in favour of the changes.

My previous Conversation about NICE talked about some of the challenges such a system will face – for example, could relationships with patients go downhill if GPs have to make difficult decisions about which drugs to pay for locally?

We know from our research with patients that many people really value their GP’s advice about what hospital to choose – is there a risk that we might trust them less if we know that they’re paying for local services as well?

Some people we spoke to were worried that more choice might bring its own problems, with the best GPs and hospitals becoming as overwhelmed as popular schools.

The prognosis

At Which? we want everyone to have access to good quality healthcare, and to get the information and support they need to make choices that are right for them.

Will the government’s changes to the NHS make this a reality, or do you think it’s in need of a second opinion?

richard says:

20 January 2011

It will a disaster – as Tory Health policies are – It is privatisation by another name. It is always the same with Tory Health policies. Especially for the elderly – I am elderly.

chris - the speaker says:

27 January 2011

Most of the NHS system that we have works quite well and man has always changed by degrees. Changing the thing wholesales is a recipe for disaster. Bit by bit – easy easy – that’s the way forwards. Throwing out the old and rushing in the new was never good and the old tried and trusted needs to be metamorphosed, not reborn.

GPs already have options to refer their patients to the best locally available treatment and that may well be up to 20 miles from home. It then remains for the patients to discuss how far they, and maybe their family, are prepared to travel for the best treatment. I know this from my own experiences. If it aint broke, dn’t fix it’. Okay, there are areas that need moving forward, but maybe not total reform
Don’t entirely throw out the old until you know that the new works. Do some field trials to sus if it works, and when the glitches have been straightened out, yes, move it nationwide, but tread carefully and don’t burn your bridges.
.

Sybilmari says:

7 February 2011

I do believe the NHS needs a thorough overhaul but I cannot see how decisions about how to do that could be made in as short a time as the government appear to have taken. There is unbelievable waste in the system but I cannot imagine GPs are up to dealing with it. Part of the problem is that the pharmaceutical companies are ultimately the ones who decide what products are available for so-called health care and they are based on making huge profits not on healing. They do not want us to get better only to remain dependent on them. Many GPs appear to be slow to understand this. I do not use the NHS and I am not registered with a GP because the last two I had were appalling. I pay for my health care, even though I am on a limited income, by going to alternative therapists who really do want to help people to get better. It is certainly working for me and at a fraction of the cost the government pays the NHS per person. My view is that the NHS should be locally based and inclusive of all alternative treatments – giving individuals the chance to find what works for them without the consumption of toxic drugs and constant waiting for appointments with specialists who then don’t know what to do or who carry out dangerous and unnecessary surgery. We pay for the NHS; so we should have choice and much more control over our own health care (as well as what goes on our records). The government could look at what other countries do before charging in to make change for changes sake. They could probably save enough money to pay off the National Debt they keep on about.

duncan lucas says:

7 January 2017

Yes I know its a very old Convo but think its appropriate . The Government has just announced it is trialling out its 111 service using BOTS ! starting off with North London due to (their words) pressure on the NHS . To say the least this is extremely controversial and already medical staff are not happy -saying -more staff not computers , many comments on International websites with one Texan hospital doctor saying they have a computer system that tells them what the diagnosis is and it is “rigged ” in favour of Big Pharma USA .Be that as it may the number of wrong diagnosis,s is enormous in places that use it for the public , mainly the US and of coarse , plenty of medical lawyers getting very rich. What do the regulars think about this ? Thank God I have lived through a pre-digital medical era . I should add -yes its been hacked in the US in the past .

John Ward says:

8 January 2017

Sybilmari [above Duncan’s post] obviously has a poor impression of doctors’ diagnostic competence and I guess is not alone, so I wonder whether this is a good idea from their point of view as well.

A bot-driven automated advice service might appeal to many on the doorstep of the NHS wondering whether or not to go in, but I can foresee reliability problems, and serious potential risks, unless the system is extremely carefully crafted and monitored. Despite the supposed ‘intelligence’ of such smart systems based on binary interrogation and on formulaic scripted responses there is a risk of misunderstandings, defective algorithms, and erroneous diagnoses. I would also consider it possible for patients to play the system to get the responses that satisfy them rather than the ones they need.

I should like to know more about this development because it also has the potential to streamline primary care and relieve the frontline pressure on the National Health Service. I am not against it in principle but there should be no place within such a system for any degree of commercial preference. It must be secure, patient-orientated, informed by best practice at every level, and trustworthy. It should never become a by-pass for clinical excellence and comprehensive care and treatment but it could be a useful gateway to the right resources. I think the world-renowned medical institutions in the UK could make it good if anyone can so it’s worth giving it a chance, I feel.

Just for info on it John – its run by Babylon health care , one investor is British -one is European and one is a subsidiary of Google (you will need to track into it to find it ).

Thank you, Duncan.

Before your comment on 07/01/2016 I knew nothing about this proposal so what I wrote above was straight off the top of my head. I have since read about it on the digitalhealth.net website [“Babylon Health to power NHS111 with ‘AI triage’ bot“] [“AI” stands for “artificial intelligence”] and it seems that my assumptions and concerns were realistic. However, there were two aspects that I did not anticipate, one good, one worrying: (a) The system will “tell people where to go and who to see, as close to their home as possible, so they can make the right choices”; and (b) Doctors “have . . . expressed concerns about the reliance on . . . self-reported symptoms for determining the severity of a person’s illness”.

The article was last updated on 6 January 2017 and is well worth reading at:
http://www.digitalhealth.net/digital_patient/48395/babylon-health-to-power-nhs-111-with-‘ai-triage’-bot

Obviously, people self-report their symptoms when they go to see their General Practitioner, but the doctor can make judgments based on how they describe them, their body language, their physical appearance, the presentation of their symptoms, and other physical signs [like their temperature and the condition of their tongue which reveal a lot]. This is not possible with a chatbot. However, as an issue it has been recognised and will no doubt be addressed.

I am not concerned about the ownership structure of Babylon Healthcare. What is more important is that its functions and performance are strictly specified and controlled by the NHS and the outcomes closely monitored.

Babylon Healthcare passed its Care Quality Commission [CQC] inspection in October 2016 and was found “to have provided safe, effective, caring, responsive and well-led services in accordance with the relevant regulations”. Another remote GP consultation service called “Dr Now” has also been provisionally approved by the CQC. By April 2017 the CQC plans to roll out a more focused regulatory regime for the growing number of digital healthcare services, many of them run by companies charging for private access to NHS doctors.

This is potentially a revolution in access to primary health care and raises several pertinent questions. It would be a worthwhile subject for a full examination and report by Which?

Ian says:

This could become a rather open-ended topic. It’s taken a while to get going (!) but it’s never been more relevant.

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