Don't ask the DoH where the NHS is going

At last the cat is out of the bag.

Health secretary Patricia Hewitt revealed last week what many GPs have suspected all along. The 15 per cent lid on private involvement in the NHS is to be officially scrapped.  

So there is no longer an ‘artificial limit’ on private provision but, at the same time, Ms Hewitt says this is definitely not privatisation of the NHS. Confused? Don’t worry, because the health secretary knows you are not quite up to speed and even acknowledged as much in her speech.  

 ‘There is a sense that the service no longer knows where it is going,’ she said. But does she know where it’s going? That’s the big question.    

And there were lots of other big questions raised about the future of the NHS last week, when the new chief executive, David Nicholson, announced 60 ‘reconfigurations’ of services, affecting every SHA in the country. He went on to suggest that health professionals needed to be advocates for these reforms so that the public would better understand, and approve of, his plans.  

Has he not noticed that NHS staff are just a tiny bit fatigued by the constant cycle of change, dearth of clear leadership and the prospect of not knowing whether their jobs will exist by the end of the year? Does he really expect cheerleading GPs to come rushing out of their surgeries to support him?  

At least Ms Hewitt will be able to take comfort in the roars of approval from private providers. Of course, companies such as UnitedHealth Europe, with a US parent company that makes more in annual profits than the entire revenue of Sainsbury’s, were never going to be happy just picking up the odd contract to run a failing practice in a deprived area. Now they will really have something to get their teeth into and, luckily for them, it seems that the number of PCTs able to offer APMS contracts may be set to double.  

This follows the news that APMS practices will be also able to hold budgets for practice-based commissioning (GP, 22 September), which is perhaps why UnitedHealth has appointed a director of practice-based commissioning.  

So it’s all looking good for the private sector. But what about that question over where all this change is leading? Ms Hewitt’s response was a masterclass in the art of passing the buck: ‘I am not going to lay down from Richmond House how many hospitals, how many beds, how many staff of each grade and each qualification, what kind or how many different providers there should be. And that is why you — all of you working in the NHS, not I — will answer the question: “Where are we going?”.’ Or in other words, ‘Don’t ask me’.     

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