NHS Reform

NHS Reform in 2021

2020 shook our National Health Service like never before. Although COVID-19 is taking most of the blame for the pressures of 2020/21, the government is also having to confront a number of pre-existing problems. But as the government ‘build back better’, it looks like they might compromise some important elements of the service.

NHS Reform

On 11 February 2021, with the NHS still on its knees after the toughest year in its 72 year history, the government published plans to make significant changes. In a white paper titled Integration and Innovation: working together to improve health and social care for all, the government sets out how they propose that the NHS can be improved, focusing on three main areas:

  1. Helping different parts of the NHS work together
  2. Improving ‘sensible decision-making’ and the use of technology
  3. Improving accountability.

Some have criticised the timing of the proposals – which in themselves are not entirely new. But the Health Secretary, Matt Hancock, says that there is “no better time than now”.

The aim of the proposals is certainly admirable. And coming as they do, after a winter which saw our health service pushed to the brink of collapse it’s hard to envisage significant opposition to efforts to improve the service. But as is often the case, the devil is in the detail, and less than a month after publishing the proposals a number of concerns have been raised.

The Healthcare Safety Investigation Branch (HSIB)

Some of the more controversial proposals relates to the HSIB. Set up in 2017, the HSIB independently investigates patient safety concerns in relation to NHS care in England and makes recommendations to improve it.

But the government is looking to take more control over the patient safety watchdog, which would be rebranded the Health Service Safety Investigations Body (HSSIB). Experts have warned that the proposals risk “massive untold consequences”. Professor Carl Macrae, credited with writing a paper which led to the formation of the HSIB, told The Independent that plans to make the HSIB an independent body are positive, but they are undermined by giving the government power to tell it what to investigate.

One contentious topic is the removal of the HSIB’s ‘safe space’. The idea of the ‘safe space’ comes from the Air Accident Investigation Branch – which the HSIB is modelled on. It provides reassurance that testimony given as part of an investigation will not be used against the person giving it; the idea is to promote honesty, so that investigations, and subsequent learning, is effective.

Some patient safety campaigners argue that the safe space is essential. Whereas other groups say that it does not promote the transparency that is key to securing the public’s trust.

Compensation in medical negligence claims

Concerns about compromised investigations are compounded by plans to overhaul how you can claim compensation for medical negligence.

For some people, this forms a crucial part of finding out what went wrong. So, whilst we welcome a review that aims to make genuine improvements, the government appears to be focusing too much on reducing spend. Although saving money is obviously desirable, it should not come at the expense of those unfortunate enough to have been victims.

The two most commonly discussed ways of saving money are:

  1. Reducing injured victim’s compensation entitlement
  2. Simplifying and streamlining the process to get compensation

Both sound straightforward, but each come with side effects.

Compensation should return an injured person, as close as possible, to where they would have been if they had not been a victim of negligence. Reducing the awards must therefore mean that this is no longer the case.

Simplifying something which by its nature is complex also has obvious drawbacks; fewer investigations will mean there is less chance to learn. Similarly any streamlining must be done thoughtfully, so as to not to have any unintended consequences.

Although medical negligence claims cost money, it’s crucial that the government remember they are not simply an inconvenient overhead; behind the numbers are real people who have had their lives ruined by negligent medical treatment. Healthcare prioritises patients’ needs and this shouldn’t stop after something goes wrong.

We urge the government to do more to actually reduce incidents. A peer-reviewed analysis, published in the BMJ last year said that “The best way to control costs, however, is to improve safety so that both patient harm and subsequent litigation are reduced”.

Abolishing regulatory bodies

Another change posed by the 11 February white paper is the power for the government to remove regulatory bodies. Despite the paper claiming that “this is not about deregulation”, it’s hard to describe the proposals in any other way.

Their rationale is that the current regulatory bodies are rigid and create unnecessary bureaucracy. They aim to reduce this, by regulating only what needs regulating; some areas, they say get safer over time, with the use of technology for example.

However, critics have hypothesised potential political motivations for these powers; such as the ability to assert influence over regulatory bodies. Nurses United UK warn that deregulation of nurses could be a tool to meet the election promise of employing 50,000 more nurses – by changing the definition of what a nurse is.

Privatisation by Stealth

Whilst patient safety campaigners pored over the plans for NHS reform, a number of interested parties signed a letter to the Health Secretary, asking for an investigation into the take-over of GP services by a major US health insurer.

The take-over of AT Medics Ltd, who run 37 GP practices across London, by a subsidiary of Centene Corporation, a US Fortune 500 healthcare insurer, is expected to create the largest private supplier of GP services in the UK.

Despite getting approval from a local NHS body, some have voiced concerns that the NHS is being privatised “by stealth”. They want an investigation to take place because of:

  • A lack of openness, transparency and misrepresentation
  • Inadequacy and secrecy surrounding the due diligence process
  • A lack of clarity regarding NHS England’s role.

This is not an isolated example though. Locally to Pryers, residents and staff have expressed concern at plans to outsource A&E work to a private company.

No respite for the NHS

After a turbulent 2020 for the NHS, we were all hoping for a better 2021. But it looks like once the pandemic is over, more battles will be fought – this time in boardrooms.

NHS staff have proven that what they lack in funding they make up for in hard work and determination. It sells them short to dumb down investigations and revoke patient rights when things go wrong. We need a system that recognises and learns from mistakes and then goes the extra mile to make up to the victims. Although it’s not impossible for private companies to offer this, you would think that profit might complicate matters; if nothing else, it contradicts the government’s other plans to integrate different parts of the NHS.


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