NHS: cultural revolution II

Fonte: aqui.

Andrew Lansley's recent announcement that the government is embarking on a two-month "period of listening" about its NHS reform plans has been seen by some as a U-turn over a deeply flawed policy.

There are, however, some areas where the government is not prepared to listen: the commitment to abolish primary care trusts, to transfer major powers to commission services to GPs, and the ambition to vastly increase the participation of the private and, in theory, voluntary sectors in providing health services. In future, the NHS will continue to be funded from taxation and (for the time being) will be free at the point of delivery, but the government will step back from running the service.

Private sector involvement in the NHS is not new. Dentistry, worth £2.1bn, opticians and pharmacies are already in the private sector. GPs themselves are effectively private contractors, accounting for £8bn, or almost 10% of the entire NHS budget. Under Labour, private involvement was extended via independent sector treatment centres (ISTCs), handling mainly non-emergency elective treatments, as a way to bring down waiting lists.

But the current proposals are much more bold. Plans are under way to further outsource central services, such as workforce development (total budget £5bn) and procurement management. Even NHS Direct (worth £146m) is in the firing line.

But what about core and non-core clinical services provided by NHS trusts and community health organisations? These could be harder to outsource. This is especially true of the most complex, unplanned hospital admissions that are costly and inherently difficult to plan for. The Department of Health's (DH) own statistics show these account for approximately £12.5bn of a total budget for "hospital and community services" of £51.5bn. But that still leaves £39bn that could potentially be subject to private sector competition.

NHS: cultural revolution

Enquanto aqui se debate se o SNS sobrevive à custa do contribuinte e não à custa dos seus promotores, na Grã-Bretanha, pretende-se acabar com o tradicional NHS, que subsiste desde 1946. Nem Margareth Tatcher conseguiu ir tão longe, como David Cameron e o Ministro da Saúde britânico, Andrew Lansley, querem ir:

• Andrew Lansley will this week publish the biggest single bill in the history of the National Health Service – one far larger than the 1946 act that set the service up.
• It will, in effect, turn the NHS from what is still, broadly, a directly managed system of healthcare into something much more like a regulated industry of competing providers – and one over which the secretary of state will no longer have day-to-day control.
• “By 2014, the NHS will no longer be a system which still contains many of the characteristics of an organisation. For example, it still has a chief executive and a management chain that stretches out from the Department of Health. Instead it will be a regulated industry in which that management chain no longer exists.”
• “The secretary of state will no longer have the power to intervene in NHS organisations which will stand or fail on their own.
• “There will be a failure regime for hospitals and other providers. But there will be no power for the secretary of state to prop them up, or intervene if something goes badly wrong.
• And unless a service is designated as protected, it will also be possible for a hospital or other healthcare provider simply to stop providing a service or operating a site from which it can no longer make money.
• Mr Lansley is committed to allowing “any willing provider” to enter the NHS market. “But with a budget that is not growing, new organisations can only enter by displacing an existing provider,” Mr Edwards says. “So there will be pressure for exit.”
• The regulator will have a duty to promote competition. How vigorously or subtly it does so, and how far it allows hospitals, for example, to integrate community and GP services providing a complete chain of provision, will depend not just on what the bill says, but on the decisions taken by a chairman, chief executive and regulatory board that has yet to be appointed. The changes are, however, profound.

Mudança. Concorrência. Revolução? Veremos. Não se pode continuar como em Portugal, em que tudo é feito contra quem paga o serviço, que é o contribuinte. E tudo é feito para defender os interesses dos prestadores (médicos do SNS, Indústria farmacêutica, administradores hospitalares, burocratas do Ministério da Saúde, outros técnicos de saúde e vários Acordos com fornecedores).