Editorial

At the time of writing, the Department of Health are in the middle of a listening exercise following the furore that broke out over the Health and Social Care Bill. I suspect that by the time this is published we will know something about what the Government is prepared to change following the listening exercise, but the Bill will be far from done and dusted. I want to take this opportunity to discuss how the Bill could be improved with a particular focus on patient safety and justice.

The first thing to say is that there could never be a better time to introduce the long sought after statutory “Duty of Candour” in healthcare or “Robbie's Law” as we have called it in our campaign. If adopted, this would be the single biggest advance in patient safety and justice since the inception of the NHS. Politically, the timing would seem to make sense as, goodness knows, there needs to be some good news for the Government over the Bill, and also the Liberal Democrats themselves acknowledge they need to demonstrate how they directly make a difference. The Duty of Candour has been a distinct Liberal Democrat policy covered in its manifesto and agreed as part of the coalition agreement. There are other concerns about the way the Bill deals with patient safety. It brings about the abolition of the National Patient Safety Agency, and there is not enough assurance that patient safety will receive the equivalent concentrated attention under the NHS Commissioning Board. It can not simply be assumed that patient safety will naturally be dealt with adequately as part of the commissioning process. (That sounds a bit like the old throw-away line that patients “will be at the centre” of everything the NHS does). Also, although it has not got much attention, the Bill provides for a shake up of health professional regulation. However, there is not enough detail to give any sense of assurance that some of the measures agreed, following intensive work on implementation of the previous White Paper, will see the light of day. There are still many things from Shipman and other inquiries that have not been addressed.

Of course the biggest headline catching points in the Bill have been the transferring of power to GP Commissioning Consortia, and the insistence on creating more “competition”, which many people interpret as “privatisation”. Without getting into ideology, one thing that AvMA has noticed over the years is that any wholesale reorganisation brings with it additional risk, and the more fragmented we make a system, the more risk is introduced. The idea of a myriad of providers with different motivations and different ways of addressing patient safety is frightening. We have seen the results of that approach with GP out-of-hours services. I have yet to see a convincing case made for competition or privatisation helping patient safety. If you have, please let me know? As regards the other big buzz word in the reforms, “choice”, most people I speak to want to know first of all that their local GP practice and local hospitals are safe before any consideration of additional choice.

Accountability is also a vitally important factor. Although it has become politically incorrect in some circles even to ask this question, I will. Why should GPs, especially those taking on responsibility for commissioning NHS services, remain independent business people? Wouldn't it make sense for them to become NHS employees – accountable like any other NHS employee? The retort is sure to be that to do this would take away the innovation which entrepreneurialism and the profit motive bring. But what is the evidence for that? Why is it that so many of the best clinicians and managers who are innovative, especially in patient safety, are indeed NHS employees and need no such extra motivation?