Chris Skidmore is the Member of Parliament for Kingswood, and a Member of the Health Select Committee. Follow Chris on Twitter.
It's fair to say that one of the most controversial pieces of legislation to pass through this Parliament has been the Health and Social Care Act. Parliament devoted hundreds of hours to the bill, rightly so given the esteem that the NHS is held in. Sadly, the political debate ended up becoming more about paranoid speculation than the practical content of the bill itself, with Andy Burnham championing the interests of the middle-managers rather than professionals and patients, claiming that there was "72 hours to save the NHS". For someone who in the final months of the Labour government was championing GP-led commissioning, it was an unfortunate corner to be backed into. Months on, the NHS remains alive and well: it has not crumbled, as some feverishly predicted. Importantly, we are now seeing the early benefits of creating clinical commissioning groups, the centrepiece of Andrew Lansley’s legislation.
Clinical commissioning groups (CCGs), are anticipated to take full control of commissioning NHS services from April 2013. The replacement for cumbersome Primary Care Trusts, they currently are in "shadow" form, though many are already being given powers, funds and responsibility for services in their local area.
The results are encouraging. For example, the Kettering locality of Nene CCG in Northamptonshire noticed that too many patients with minor injuries were presenting at Accident and Emergency Departments. Not only does this cost money, but it also increases queues unnecessarily. To ameliorate this, they have trained their nurses to provide minor injuries care, even eliminating the need for many patients to see a GP, let alone make a trip to a local hospital. Simple, straightforward, and an example of where local knowledge and the freedom to innovate can save money and provide better care. At a time when the NHS is tasked with making £20 billion of efficiency savings by 2015, the cumulative effect of these small interventions is potentially transformative.
Or take the case, just up the road, of the Corby CCG, which has managed to cut the number of GP referrals made by 25% and save £300,000 in the process. This was done by reviewing all referrals before carrying them out, to ensure that people were not being sent to consultants to deal with problems that can be resolved in primary care. By keeping these reviews within individual GP practices, the people making the decisions are those closest to the cases.
Another example of a CCG saving money and making life easier for patients comes from the South Devon and Torbay CCG, where a large number of men needing blood tests for a specific prostate issue were originally obliged to make several trips to an outpatient clinic. Now a system has been introduced whereby tests are done locally, and they are contacted with the results, saving time, money and inconvenience.
Taken individually, these are not revolutionary changes, merely sensible, practical improvements. Yet it shows what can be done when care is localised, and control over its commissioning is given to GPs.
The aim is to put patients at the heart of the health service, and shape it to their needs. What we are seeing is that this is best done by the professionals who know their patients and their area, rather than unaccountable distant managers. As Dr Peter Weaving in Cumbria puts it, "GPs' activities account for 80% of the healthcare spend in the country, so it's only right that they understand the impact of the budgetary decisions they make." GPs want what is best for their patients, and know their patients. It is only logical then to ensure that they are the ones who are in control of acquiring the services that are needed.
As Conservatives, we have always been there for the NHS. But we are also prepared to take bold decisions in order to deliver the best service possible, maximising its productivity and reducing waste. We must not be afraid to confront the reactionary left head on, just as we should be prepared to stand up for our record on the NHS. Yesterday's announcement, for instance, that health authorities will be reuired to publish data on available drug treatments is another milestone down the road of transparency that we have set ourselves upon, creating an open NHS in which services will be accountable to patients. It is they who deserve the best possible treatment, on whose behalf there can be no excuses for poor standards of care. In the teeth of the vested interests of those who would preseve the status quo, enancting change can be uncomfortable. But we must argue our case, continuing to press home that the changes we make will benefit every patient. We know that for their sake, reform is not an option but a necessity.