The NPC states that the white paper represents the ‘biggest change to the NHS since its foundation, and constitutes a move to an entirely different model of healthcare that carries significant and unacceptable risks for older patients, staff and society as a whole’. The briefing concludes that:
• A market-based model of healthcare would raise serious questions as to accountability, standards and equity of health outcomes whilst threatening the principle of a comprehensive service available to all based on need, rather than the ability to pay.
• The Coalition government has no electoral mandate for such wide-ranging proposals, and should embark on much wider public consultation and agreement before proceeding.
• The introduction of the “any willing provider” principle will lead to the fragmentation of services. This is at odds with the wishes of many older people who feel that the choice of treatment is often more important than the choice of provider.
• There is a serious risk that care will be diverted to those people who are most profitable to treat, rather than those who need it most. Older patients often have complicated, ongoing and expensive care needs which a health system based on profit will not be willing to address.
• The proposal to hand 80% of the NHS commissioning budget to GPs and force them to set up local consortiums is a retrograde step, which will lead to further privatisation, weaken the gatekeeper role of GPs and destroy trust with patients.
• One of the most important aspects for older patients is that they receive continuity of care with a doctor they know, and quality comprehensive care at their local hospital. The choices proposed in the white paper are therefore largely illusory for those who need health care most.
• A market-based system with a large number of healthcare providers, demands an even greater need for proper independent regulation, accountability, public involvement and scrutiny. However, the white paper lacks any real detail in this important area.
• Reshaping the health service will cost billions at a time when the country can least afford it, and will divert staff attention away from the most important task of improving patient care.