So the Coalition government has had to step back from its proposed reforms for the NHS, having considered it best to accept the recommendations of its independent commission. This has the benefit of keeping the Liberal Democrats happy and saves the face of Nick Clegg their leader and Deputy Prime Minister. The main concessions then appear to be to:
? Limit competition from the private sector.
? Involve hospital doctors and nurses together with the original General Practitioners (GPs) on commissioning panels for care and managing the associated budget.
? Have no fixed deadlines for implementation of changes.
The government is spinning the outcome as positive saying that health professionals are now back on board (where they should have been before launching the initially proposed reforms of course!) with the proposed changes having the support of patients and professional bodies, as well as back-bench Tory and Liberal Democrat MPs. The legislation is said to have been improved by such scrutiny with the Liberal Democrats claiming a lot of the credit, despite the Coalition only trying to build on what the previous Labour government had started to try and do i.e. to involve the private sector to meet demand over and above what the public sector could support.
One Liberal Democrat back-bencher commented that their efforts had mitigated the effects of untrammelled competition and if local communities did not want competition, they would now be able to call their local health commissioner to account. However, other feedback from the medical profession saw it as now more like a dog?s breakfast!
After all this we are now left with the situation as Nick Robinson the political correspondent of the BBC put it, if the general public did not know before how the NHS worked, they certainly do not understand now:
? how the NHS would have worked with the originally proposed reforms or
? how the NHS will now work in the future with these changes.
If the general public does not understand the problem of the NHS, it becomes an almost impossible task to convince.
The main issue seems to be a broad public unease about profit-making by the private sector in the provision of public services and this includes the Liberal Democrat partners in the governing Coalition, with Nick Clegg calling on Monitor, the health regulator, to promote collaboration among providers rather than competition. However, the UK is unusual among rich democracies in how little private involvement there is in public service provision with e.g. only 4% of acute-care beds provided by private companies. Given that the German economy is held up as a successful example and driver for the European Union of Member States, it is instructive that (according to The Economist of 21st May, 2011) the proportion of for-profit hospitals at 32% already exceeds the 31% of publicly-run ones, with the rest operated by charities and voluntary organisations.
It is ironic that the original idea of putting the care budget of the NHS in the hands of GPs (such family doctors being private operators since the foundation of the NHS in 1947), was aimed at reducing the high cost item in the NHS budget of hospital care by their also finding lower-cost solutions sometimes only involving primary care and not always hospital beds e.g. for elderly patients.