White paper ‘could hit patient care’

The reforms outlined in the health white paper will hit morale, jobs and skills, but are unlikely to improve patient care and could hit quality and safety, an EHI Primary Care survey has found.

A picture of little support for ‘Equity and excellence: Liberating the NHS’ emerges from the exclusive survey of 400 staff working in strategic health authorities, primary care trusts and health informatics services that was conducted this autumn.

One of the key findings is that more than 50% of those who took part believe it will lead to worse patient care, with 25% predicting that care will deteriorate greatly and 28% predicting it will decline by a small amount.

A further third (33%) expect to see no change in patient care from the white paper, which sets out plans to scrap SHAs and PCTs, to devolve secondary care commissioning to GP consortia, make all NHS trusts foundation trusts, and involve councils in public health.

Asked to pick from a list of potential benefits of the white paper, 33% said there would be no benefits at all. Although 21% thought the reorganisation would cut needless bureaucracy, just 7% thought it would put the right people in charge of commissioning, and just 4% thought it would end political interference in the NHS.

Asked to pick from a list of potential dangers in the white paper, 26% expressed concern that the upheaval could distract attention from quality and safety, 21% expressed concern that the commissioning changes would lead to a loss of accountability, and 19% worried that the reorganisation could lead to a financial crisis.

Almost one in five respondents were concerned that the commissioner and provider changes would mean more private sector involvement in the NHS.

Comments made by respondents showed that many are weary of NHS reorganisations, have little optimism that the latest plans will make a difference, and are uncertain about where IM&T will fit into the new structure.

One respondent said: “Same old story, more money wasted in setting up the new and making redundant the old.”

Another said: “Projects are stopping without any understanding of the future needs of the organisation. There is no clear direction.”

The poll, completed by 403 NHS staff working in IT, general management and commissioning, found that most (59%) believe the changes will lead to a cut in IT investment, although 29% said they expected spending on IT to be halted and then refocused. Just 2% believed investment would increase.

Many respondents, a significant proportion of whom have worked in the NHS for more than 20 years and are in senior roles, feared the loss of “organisational memory” and “accumulated knowledge” by NHS staff.

One respondent said: “It will take GPs a considerable time to gain the skills they need to manage the service.”

Another said: “The loss of very specific NHS skills, particularly in areas of information governance, will be lost to the profit making private sector.”

The EHI Primary Care poll was conducted between 20 August and 17 September. Survey respondents included department heads (12%), senior managers (33%), junior managers (17%) and staff members (20%).

Most (78%) had worked for the NHS for more than five years and a fifth (20%) for more than 20 years.