The NHS is in a state

The NHS is in a state…..of flux.  With Andrew Lansley taking over in the health hot seat after the last general election, he took no time at all in letting us all know his vision for the future of the NHS.  So radical were these plans that they did not make their way into the Conservative Party election manifesto.  You can read about these changes in the many papers he has published but two of the most pertinent are Equity and excellence: Liberating the NHS and Healthy lives, healthy people: our strategy for public health in England.

The future is GP lead commissioning with the removal of PCTs and SHAs.  OK, fine.  Are all GPs in it for the love of the job or are they in it to make money?  Do they want to give the face to face bad news to a patient that they think the money they could spend on some life extending drugs for them, will actually be spend to fund operations to save the lives of 4 children.  Tough call.  This kind of bad news is currently handled faceless administrators in the PCTs.

Traditional geography will disappear in the form of Primary Care Organisations and Strategic Health Authorities.  How will health use Geography – or not – when the NHS is restructured?  It is certain that the lowest geographical unit will be the GP Practice, but that doesn’t have a defined geography.  A patient can now register with any GP, anywhere they like.  Each GP must organise himself into a GP Consortia creating a cluster of GPs, again, with no defined geography.  The Public Health paper does state…. p. 62 Paragraph 4.5 GP consortia will have responsibility for the whole population in their area.  How?  The population that are registered with a GP are covered, what about those that aren’t?

Do we need defined health geography as we have had?  Perhaps not.  A GP Consortia will have to report to a Local Authority, could be more than one, but to report health statistics at Local Authority level would be unhelpful for health inequalities and health needs analysis, regeneration, service planning.  Would publication of health information be better at lower levels?  I think so.  Make more use of Lower Level Super Output Areas.  These are well established building blocks which are small enough to identify areas of need within a Local Authority.  Small numbers may be a problem, but there lies another issue.  Information Governance around health information is tight to say the least.  Should it be?  To be honest if I thought my health information was being analysed and would inform decision makers on more appropriate service provision or targeted intervention programmes, I don’t care.  I’d probably already have posted it on Twitter or Facebook anyway!

A post on the Guardian DataBlog Few patterns in GP commissioning pathfinders on 12th January 2011, reveals a lovely map, using Google.  Last month the DoH named the first 52 pathfinder consortia. Information from eight of England’s 10 SHAs revealed GPs have grouped into around 260 consortia, suggesting there will be 300-350 nationwide.  DoH national clinical commissioning network lead Dr James Kingsland warned the figure was ‘frighteningly similar’ to the original number of PCTs. There were 302 PCTs before mergers in 2006 created the current set of 152

Each Pathfinder Consortia does include a geography, mostly Local Authorities or Counties.  An interesting point is raised “…The range of sizes and types of consortia allows for experimentation. It might cause problems later as the remaining GP practices have to choose a consortia to join, and could be forced to fill in the gaps – although it’s possible they would be able to join existing consortia. And health secretary Andrew Lansley is clearly more interested at this stage in trying new models and seeing what works, rather than keeping the picture tidy.”

In my day job I have been trying to engage with Policy people but with little success.  It would appear that the NHS restructure does not consider Geography to be very high up on its list of things to do.  What I find worrying, is that resolving the issue of Geography within Health may be a done deal already without any consultation or expert advice.

Perhaps DoH has a Plan B up its sleeve anyway and the reforms are just too big a deal?  Time will tell.

Republished with thanks from Graham Hyde's blog: http://allthingsgeo.wordpress.com/2011/01/13/what-about-the-geography/