Indecision about me, without me? A survival guide to the new NHS in England

The UK government’s health reforms are edging ever closer to being enshrined in law. They represent a massive shake up of the structure and funding of health care in England, and the care people receive for long term conditions is right at the heart of the changes. But that doesn’t mean the NHS and diabetes care is safe – far from it. Read on…

We have followed the progress of the health reforms carefully since they were introduced in the White Paper ‘Equity and Excellence: Liberating the NHS’ in 2010. This paper lays out the plans to hand funding for local health care to groups of GP practices, to be called Clinical Commissioning Groups (CCGs). It also shows how public views of health services will be incorporated more effectively into planning, through an organisation called Healthwatch England. The CCGs will be able to commission, or in other words buy, care from any provider that meets the needs of their population. Some services will be centrally commissioned by a body called the NHS Commissioning Board.

Public health is also receiving a makeover, with Directors of Public Health being appointed for each locality. These posts will be closely linked with local authorities, and detailed plans for this service are being announced shortly.

Meeting people’s health needs more locally and more effectively is one of the main promises of the reforms. The aim of making sure that people are much more involved in decisions that are made about their condition and treatment is also emphasised. The phrase ‘no decision about me, without me’ is used to describe this, and indicates the ambitious nature of the proposed changes. More choice is envisaged too, with, for example, the chance to choose a GP away from the area where you live (for example, nearer to your workplace), and also the ability to change your GP more frequently and easily. 

Some of these ideas sound pretty good – more choice, and having more of a say in your consultations, can be a good thing. So too giving more purchasing power to local GPs who well know the needs of people using their services. However, it’s one thing to commission economic and prompt services for procedures such as cataract surgery or hip replacements, but quite another to ensure that diabetes is looked after properly. This includes a lifetime of screening for complications, the provision of regular and accurate prescriptions, occasional unpredictable acute episodes that might require hospital stays, plus an ongoing structured education programme being in place and monitored.

The changes proposed above have yet to become law. The Health and Social Care Bill is still going through parliament, and there is still a huge amount of detail being argued about. There have been a number of amendments already and may be more, as those who are against the current format try to curb its more extreme measures and protect the NHS as a national organisation by ensuring the Secretary of State for Health retains overall accountability for its performance. 

There is so much to consider, and so much associated politics, it would be easy to patiently await the ‘brave new world’ when the Bill becomes law. On the other hand, there is much at stake. The last decade has seen unprecedented advances in diabetes care in terms of treatments which are inevitably more expensive, as well as more structured care and an increased emphasis on the availability of structured education. It has resulted in more people than ever receiving systematic appointments for annual review, which in turn results in less complications or at least the complications being detected and treated earlier. It’s possible that ignoring the impending NHS changes might mean sleepwalking into a minefield of disorganisation and fragmentation of all this good work. Another huge ‘but’ is that the changes are already starting and they have to be delivered at the same time as 20 billion pounds worth of savings have to be found by the NHS, on the Government’s orders,  to help deal with the ongoing economic crisis in the country as a whole. 

Everyone knows that reorganisation is costly, even thought it is meant to save money in the long run, and it’s also said that ‘the best way to predict the future is to invent it’. Since the consequences of any changes made will affect people with diabetes themselves, we have created a mini ‘survival guide’ to the new NHS so that you can look after yourself or your loved one with diabetes, and you come out of it with your diabetes care intact, even if there is chaos in the system during the changeover period. 

The SD Survival Guide to the New NHS:

• Find out what’s going to happen locally – via your diabetes service, your GP or your Primary Care Trust website – find the contact details via www.dh.gov.uk or www.nhs.uk. You don’t always have to make an appointment in person, you can phone or email them and ask them to update you regularly, and some websites allow you to sign up to be informed of the latest developments
• Read about the NHS reforms in relation to diabetes, for example via NHS Diabetes (www.diabetes.nhs.uk) or Diabetes UK (www.diabetes.org.uk)
• Keep track of the changes and the Health bill’s progress towards law, via its pages on the UK parliament website, at www.parliament.uk (search Health and Social Care Bill, 2010-11) and sign up for automatic updates
• Spend a bit of time thinking ‘what if’ in relation to your own diabetes care. For example, ‘what if my GP decides to buy care from a different hospital than the one I go to at present?’; ‘what if I decide to change my GP?’ ‘what if I don’t’ receive the recommended level of care from a new provider?’ etc. The issue for you will be individual, but from this you can create questions to put to your local services
• Contact your MP and ask about the changes and how they will provide for diabetes services in your area. Again, you can email or tweet as well as attend their surgery in person. If you don’t know who your MP is, now is the time to find out! There’s a complete list of MPs at www.parliament.uk/mps-lords-and-offices/mps/
• Be aware when your annual review for diabetes is due, and ensure you have an appointment for it as the time approaches. If your appointments are postponed or changed, ensure you have a new date rather than an open invitation to attend
• Be proactive: if there are changes to your local service, don’t assume you will be given information or a new service will understand exactly what you need – ensure you have a contact number and remind yourself to check regularly what is happening.
• Ask questions: you or your loved one with diabetes are the ones who will be affected by changes, especially as a new system is put in place. Keep a list of questions and don’t be afraid to ask them!

We want the new NHS to be even better than before, and also to provide the very best diabetes care. The proposed changes offer a lot of potential – but it can’t be realised alone. We all have to do our bit as architects, building the system that creates the reality of ‘no decision about me, without me’. 

What’s your view of the NHS changes?  Are you worried what might happen to your diabetes care or confident that your needs will be met?  The discussion is open!