Today’s review of emergency care in the NHS takes place against the backdrop of increasing pressure on A&E departments and renewed speculation about an NHS ‘winter crisis’ – a feature of the NHS in the past which Labour managed to eliminate in office.
Another important part of the backdrop for all this is the closure NHS walk-in centres in many parts of the country.
These centres, often open between 8am and 8pm, are popular with the public. They are ideal for people who don’t want to take a day or half day off work to see a doctor, families dealing with sudden illnesses or minor injuries and people who fall ill while some distance from their GP. They also take pressure off overstretched A&E departments. Yet a quarter of these centres have been closed since the last election and this week Monitor, the NHS regulator for England, issued a warning about the effects of such closures.
In the area I represent, two out of three local walk-in centres – one in Wolverhampton and one in Dudley – are under threat.
Why is this happening? Part of the answer lies in how decisions are now taken following the government’s reorganisation of the NHS. The reforms entailed a huge shift in power from patients to those providing NHS services, in particular GPs. Many GPs have never liked NHS walk-in centres, or the new ‘Darzi centres’ (new GP surgeries in areas with too few doctors). From their point of view these developments were unwelcome competition which they saw as using resources which may otherwise have gone to them. They prefer the traditional dual provision of the GP surgery and the local hospital, regardless of the opening hours of the GP surgery.
GPs, through local clinical commissioning groups, now control a huge chunk of the NHS budget. They decide what is provided and they are deciding against NHS walk-in centres. Closures may benefit their surgeries as patients are forced, through the removal of an existing choice, to use the local surgery (or go to A&E) but, certainly in some cases, this will not be the best outcome for patients who like the convenience of the walk-in centres.
This question goes to the heart of the government’s NHS reforms. The off-the-shelf reaction to any Tory reform of the NHS is usually to call it ‘privatisation’. But there is something else going on here. It is less about ‘who provides’ and more about what is provided and how convenient is it to the patient. In deciding this there has been a shift of power away from the users of the NHS. The real banner for the government’s reforms is ‘all power to the producers’. If anyone proposed giving the NUT control of the schools budget the Tories would choke on their cornflakes but that is pretty much what has been done with a big part of the NHS budget. And the argument that innovations such as walk-in centres ‘take resources away from local GP services’ is exactly the same argument as is used by underperforming schools and defensive local authorities against educational innovations such as UTCs or new academies.
So how did the Tories end up adopting such a policy? The answer is that, in opposition, they developed a hatred of Labour’s targets for things like treatment times, a dislike shared by many of the powerful interest groups in the NHS who thought these guarantees for the public deprived them of power. On one level the vested interests were right: the targets did remove some of their power but for the explicit aim of ensuring that the public got a return on the huge investment they were putting in to the NHS. And the results were huge falls in waiting times for elective surgery, which, left to themselves, the interests within the NHS had not delivered. The ‘target culture’ may have become too elaborate in places but it was both right and popular to expect better and quicker treatment for such a large and sustained injection of taxpayers’ money.
When the Tories got into government, they watered down targets such as seeing your GP within 48 hours or the incentives for late GP opening with the result that fewer surgeries in England now offer late opening compared to a few years ago. More broadly, they drove through reforms which are now resulting in the closure of the walk-in centres.
Professional input is a good thing and the providers of services should be listened to in any structure. It is right that GPs should play an important role in the design and delivery of NHS services. But it is important that public services, be they schools or health services, should be run in the interests of the public, the users of the services, not in the interests of those providing them.
When the secretary of state for health defended the closure of walk-in centres in the House of Commons he quoted, without irony, the BMA as saying it wouldn’t cause a problem. But the BMA represents the producer voice, not the consumers. It should be the secretary of state’s job to speak up for the patients and ensure that health services are delivered in a way that maximises convenience and ensures high quality. In relying on the producer voice to justify these changes, the secretary of state is not doing his job.
NHS walk-in centres are closing because the patients’ interests in the new NHS have been downgraded and the government has allowed decisions to be taken in a way that puts the public interest behind the interests of service providers. This is a fundamental feature of the government’s health restructuring. Labour’s response should be to ask how we can put patients’ interests back at the heart of the NHS.
This article was first published on Progress online 13 November 2013.