The coalition government’s Health and Social Care Bill is one of the most controversial reforms it has undertaken to date. The new NHS structure changes brought into effect by the bill have changed the way key services within the NHS will work in the future. The bill seeks to tackle changing social circumstances like increased longevity, and the growing need for home care etc. As well as changing economic pressures. The coalition’s proposals were first introduced in 2010, but had to be put on hold due to strong criticism and opposition from various quarters, including the British Medical Association.
One key aspect of the NHS structure changes means putting doctors directly in control of managing budgets and deciding how and what to spend on. The changes have put competition at the heart of the commissioning process within the NHS, which means that internal competition will be a driving factor in the commissioning of different NHS trusts and services. There are concerns that structural changes like these are the last thing that the NHS needs at a time like this, and that the changes will make the system even more fragmented and divisive, when really it needs to be made more cohesive for better functioning.
The NHS structure changes that have come into force strike at the very root of how the NHS delivers its services, and so is bound to have an impact on each and every aspect of the organisation. So how might these sweeping NHS structure changes affect the field of emergency care? And what kind of effects might paramedics expect to see in the future due to these structural changes?
As one senior paramedic interviewed by the BBC about the changing NHS trusts says, the work undertaken by the emergency services involves a variety of different cases. About 5% of the work on average involves life threatening cases, while about 20% – 30% involves dealing with serious cases like angina, the remaining calls are about relatively minor injuries and health problems. Paramedics and emergency health staff are competent at dealing with a variety of health issues and injuries, and are the first point of contact for emergency callers. Paramedics have the opportunity to offer the right care at the right time, which often considerably reduces the potential load on Accident and Emergency departments.
The new NHS structural reform will mean that now financial viability and competition from different private service providers will be a key factor in service commissioning. This means that a particular service may be commissioned in a particular location simply because it proves to be more financial viable. This can put even more pressure on emergency services than there is currently, and make it particularly difficult to signpost patients for treatment. At the same time, severe spending cuts and the slashing of services and staff will mean an increased workload, and the squeezing of resources within the emergency services.
The changes to the way services are commissioned will mean that there are essentially a very small number of specialists who will be in charge of deciding what should be happening within departments or services, so there will be a few people deciding where and how money should be spent, and an increased competition within private service providers to get commissioned.