The UK’s Health and Social Care Act, which will come into force in April this year, has been the center of controversy in England. The Act is the greatest restructuring of the English National Health Service (NHS) since the service’s inception. Some see it as a much needed reform to keep the system functional; others see it as a brash privatization measure that will sound the death knell of the public healthcare system in England. But what is really at the heart of the controversy?
Here are some of the issues:
1. CLINICAL COMMISSIONING
Clinical commissioning aims to put general practitioners in charge of allocating funds as members of clinical commissioning groups. The goal is to put decision-making in the hands of physicians who, in theory, are better placed to know their resource needs than the regionally based trusts which currently make those decisions.
Opponents of the plan argue that doctors will not have the time or the inclination to essentially become managers. Many also fear that this change will lead to a fragmented and inconsistent healthcare system.
2. COMPETITIVE ALTERNATIVES
The Act also aims to provide patients with more choices by giving them access to alternative private providers and by fostering competition within the system. These providers will need to be licensed before being able to deliver care.
Opponents see this as a dangerous opening that could eventually lead to a partially – or even all-out – private healthcare system.
3. IN ADDITION, THE NHS IN ENGLAND IS BEING ASKED TO MEET THE NICHOLSON CHALLENGE, WHICH INVOLVES CUTTING £ 20 BILLION FROM ITS BUDGET – ABOUT 25% – BY 2015.
These changes will apply only to the NHS in England and not the rest of the UK.
Many have questioned the extent of the changes and the time frame for their implementation. The UK already has one of the most efficient public healthcare systems in the world, as the following statistics suggest:
- Healthcare spending as a percentage of GDP:
8.4% in the UK 10% in Canada
- Percentage of total healthcare spending funded by the government:
87.4% in the UK 70.4% in Canada
- Per capita government spending on healthcare:
$ 2434 in the UK $ 2585 in Canada
- Per capita spending on healthcare from all sources:
$ 2784 in the UK $ 3672 in Canada
Furthermore, the NHS is the largest employer in the UK.
“Why fix what is not broken?” the thinking among opponents of the Act seems to go. However, with an aging population and the global economy on a knife edge, the UK undoubtedly has to find new efficiencies in the NHS in England sooner or later.
With all this in mind, we can only wait and see what the Health and Social Care Act’s true impact will be.
All statistics taken from most recently available WHO data. See: http://apps.who.int/whosis/data/