Phil Hunt on the problems now emerging as a result of the government’s marketisation of our NHS
Disturbing evidence is emerging that the Coalition’s highly controversial changes to the NHS is delivering huge variations in access to services throughout the NHS. A report by the NHS Information Centre shows a big difference in the use of new innovative medicines, depending where people live, with an extraordinary ten-fold variation between different areas of the country.
When assessed against NICE estimates, up to a third of medicine groups (i.e., medicines used to treat the same condition) fell below expected usage. In one shocking example, affecting patients with metastatic renal cancer, one in three did not receive NICE approved treatments because of where they lived.
Although some variation in practice is expected due to demographic differences, clinical need, and patient preferences, such wide unwarranted variation in practice is entirely unjustified in a national service. It all seems symptomatic of a growing postcode lottery under this government, and a recent survey by GP magazine has found evidence of a rise in the local rationing of NHS treatments and services. 71% of the 315 GPs surveyed reported increases since April 2013.
GPs also reported greater difficulty accessing community nursing care, counselling services and treatments such as cataract surgery and IVF; and GP leaders warned that cuts to local services were damaging patient care. Indeed, the survey found that rationing of care had increased ‘significantly’ in the past nine months, with one GP partner in England noting how “huge cost pressures” were “resulting in increased rationing and fragmentation of services to reduce costs”; and another observing how it was “becoming intolerable and now dangerous”.
Primary care is similarly affected. Results of the 2012-13 GP Patient Survey show 10% of people were unable to get an appointment to see or speak to a GP or nurse last time they tried (varying from 5% to 21% across the country by CCG). Of those able to get an appointment (87% of all respondents), only about half (49%) could on the same day or the next working day; 33% had to wait a few days and 15% waited a week or more.
In addition, 22% said that they had tried to contact their GP practice before attending the walk-in centre, but either found that no appointment was available (14%), or not available at a convenient time (4%) or within a suitable waiting time (3%), or they simply could not get through (1%). 24% said they did not try to contact their GP practice because of perceptions that they would not be able to get an appointment that was convenient.
The NHS is now in danger of becoming a multi-speed service depending on the accident of where you live, which in a ‘national’ service is completely unacceptable. Alongside the marketisation and fragmentation of so many services, the very future of a comprehensive NHS is at risk.
Lord Phil Hunt of Kings Health is Shadow Health Minister in the House of Lords
Published 26th February 2014