Is This the Unkindest Cut of All?


By Richard Lutz

The radical surgery being carried out on the NHS has thrown up a wide range of criticism in the past fortnight. And more will surface as Britain takes in the official announcement finally made by the government earlier this week.

The dust will settle and many huge decisions will be revealed as not only controversial but, say many, actually retrograde.

Each day, another expert pitches in to explain how the revamp, which will save according to health secretary Andrew Lansley, £5b in three years’ time, will damage and not improve our free health service.

Today comes another warning- this time on the crucial subject of medical ethics.

Dr Anne Marie Slowther, a Coventry GP and a medical academic at the University of Warwick specialising in health ethics, says family doctors are simply not up to scratch to cope with vital decisions.

She says GPs do not have the training nor experience to decide where or how local funding will be allocated. ‘They will have to decide whether, for instance, a patient with bowel cancer or a patient needing rehabilitation from a stroke will get the cover. They are difficult decisions.’

Usually the 150 Primary Care Trusts- now due to the axed- help decide who gets what.

But the new GP consortia, which won’t have this expertise, will have to make the decisions.

And, says Dr Slowther, this will lead to another round of ‘postcode lottery’ where you get the care you need depending on where you live. ‘The chances are this will happen more.’ she warned.

She now calls for urgent training so the doctors, who will take over the PCT responsibilities, have the background to deal with ethical decisions.

Dr Slowther, who is a founding member of the UK Clinical Ethics Network, added another problem. With family doctors having to join local consortia once the PCTs are abolished, they could find their individual ethical decisions clash with theirown  consortium’s principles. ‘It could lead to conflict,’ she said.

The reforms are wide ranging- the biggest since the NHS was born almost 63 years ago. The government wants to chop out what it perceives as unwanted administration costs. This will lead to reducing white collar managerial staff in the NHS by 24,000; killing off the 152 Primary Care Trusts that handles funding; and, allowing doctors to manage 80% of the NHS budget.

It will cost £1.4b. But Mr Lansley says £5b will be saved by the end of 2014/15 and £1.7b saved each year after that.

Dr Slowther’s comments add more fuel to the fire about whether this huge reformation will actually be the healthiest of cuts or whether it will actuallhy reduce the medical cover that the post war genrations have enjoyed.