Q: Do you think the Government’s ‘listening exercise’ will lead to any major changes to the proposed NHS reforms? And what elements would you advise the coalition to change or revise in order to satisfy critics?
A: The difficulty is the fact that the Prime Minister (PM) has aligned himself so closely with the reforms. To back off now would be an admission of defeat for him personally, and that is politically not do-able. Of course, there is the other dimension of the Lib-Dems and there has to me some attenuation of the reforms to demonstrate that the Coalition is not a one-way street.
What would I expect? Some widening of the board membership at consortia level to include nurses, maybe, although Lansley is in no mood to mollify them after being beaten up by the delegates at the RCN conference. I would also expect some involvement from hospital consultants, which the PM seems keen to include, and the public, which is a big Lib-Dem ‘thing’.
If the Bill stays as it is Monitor has the power to impose competition at any level of service delivery. This might change following the review to passing the decision to commissioners to decide.
The final issue is that the Bill allows the Secretary of State to surrender his ‘duty’ to provide comprehensive healthcare, to working ‘with a view to’ providing services. I think the status-quo might remain.
Q: Will the new competitive climate make it easier, or more difficult, for medical device companies to pitch to NHS procurers?
A: Selling devices to the NHS is very difficult. The NHS does not have a single front door and manufacturers find that confusing and expensive to deal with.
As hospitals all become foundation trusts (FTs), and probably a good few social enterprises, it will clarify who the customer is and where they are.
Device companies will have to re-invent field forces and realise there are 400 customers to deal with and all different. The future will not be easier, but it will be less complicated. FTs will be looking for innovation that saves money in the care pathway – that’s the trick.
Q: With so many new players coming into the marketplace, and following the axing of the National Programme for IT, do you think organisations will have the technology they need to provide joined-up care? If not, what is the best way to ensure coverage, but protect vital patient data?
A: Thank goodness we still have the spine. That is the one thing the NHS has in common. I think the industry will have to get its act together with platform standards, otherwise we will end up with an electronic Tower of Babel.
GPs are quite IT savvy. They made excellent progress with products like EMIS and others and they recognise the benefits. So, I think they will look for IT compatibility and start insisting, as commissioners, on better use of IT, with electronic discharge papers and so on. They may well drive the changes from the ground up.
Access to patient data is, in my view, over emphasised. I see no reason why our patient records should be the property of the Secretary of State. I think they should belong to us. If they did, where they are stored would change. Google and Microsoft Vault are often spoken of as a possibility. Why not?
Q: Do you think hospitals will be forced to close and, if so, how many and how will the services they provide be replaced?
A: Up to a third of the secondary care estate might be vulnerable. The exact number is impossible to predict, but a good indicator will be the number who fail to make foundation trust status. Closures will be dressed as rationalisation.
It is probably true that advances in paramedical techniques means ‘play and stay’ is now safer than ‘scoop and run’ and ambulances can travel further to bigger and better-equipped A&Es and take patients to episode-specific locations – heart attacks to cardiac suites and so on. Thus fewer A&Es are a potential and that opens the door to rationalising services that sit behind the blue-light front door and centring instead on excellence; putting elective surgical care in one place.
The demand for beds will grow around medical elderly care and some of the hospital estate is likely to be taken over for that specialist purpose.
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