In the latest in a series of articles marking the coalition Government’s first anniversary in power, Health Editor Barry Nelson looks at how the NHS has fared over the past year.

FIGURES provided by NHS organisations in the region show that the Health Service’s overall budget and workforce continues to increase, despite national headlines about public sector spending cuts.

Even more remarkably, despite hundreds of jobs being cut from management and administrative posts across the region, the NHS – in the North-East at least – continues to perform as well as in recent years.

Prime Minister David Cameron promised to ringfence NHS spending shortly after coming to power.

According to figures obtained by The Northern Echo, it seems that in the year since the coalition Government was elected, that promise has been kept.

While a small number of services have been withdrawn – notably free NHS IVF infertility treatment in North Yorkshire – the overall picture seems to be that it is business as usual for the NHS.

In the majority of cases, the budgets of NHS trusts have risen in the last year.

And while there has been an emphasis on trimming management posts, in most cases the total numbers employed by NHS organisations have also risen in the past year.

When Health Secretary Andrew Lansley published his radical proposals to shake up the NHS last summer, there were fears that the health service’s steady improvement in performance might falter.

His vision was of “cutting out the middle man” by abolishing primary care trusts (PCTs) and strategic health authorities (SHAs) and giving 80 per cent of NHS budgets to groups of GPs to spend on behalf of their patients.

He also suggested that greater competition – and greater involvement of the private sector – could provide better value for money for the taxpayer.

As a result of reductions in management costs ordered by Mr Lansley, a total of 428 managerial and administrative posts have been lost in SHAs and PCTs across the North- East in the past year.

This amounts to a £27m annual saving on management costs in the North-East.

A total of 604 full-time equivalent posts have vanished from management structures in Yorkshire and the Humber during the same period.

The reform plans have seen the announcement of clusters of GP ‘pathfinders’ across the region, which are trialing the new commissioning arrangements before the handover, which is due to take place in 2013.

With the announcement that Mr Lansley was also seeking £20bn efficiency gains across the NHS by 2014-15 – to enable an extra £1.7bn a year to be reinvested in patient care each year – surely something had to give?

But David Stout, acting chief executive of NHS North- East, said: “The Government has made it clear that patients should not expect a return to long waiting times and the North-East continues to perform very well against all national standards.”

Now all eyes are on Mr Lansley to see whether his reforms survive a “listening exercise”, after Mr Cameron intervened to put the proposals up for further discussion.

GP impressed by ‘ambitious’ reforms

LONG-SERVING County Durham GP Dr Stewart Findlay has been impressed by the coalition Government’s health policies and hopes Health Secretary Andrew Lansley is allowed to carry out his ambitious reforms.

A family doctor with nearly 30 years experience, Dr Findlay is spokesman for the County Durham and Darlington Pathfinder group of GPs, set up to test out new commissioning arrangements due to come into force in April 2013.

Dr Findlay was frustrated that the last Labour government’s attempts to get GPs more involved in commissioning services were too bound up in red tape.

The Bishop Auckland GP believes that handing about 80 per cent of the NHS budget to clusters of GPs has the potential to bring great improvements for patients and the wider NHS.

“It just seemed to make so much sense for us,” said Dr Findlay. “That the people who are in contact with patients most of the time were going to be commissioning services for them.”

In practice, if a patient has problem with the provider of a service, the first person they turn to is their GP.

“We usually know at a very early stage whether our patients feel that a service works well and provides a good quality of service,” he said.

“Before any official statistics come out, we already have a feeling whether a service is working or not.”

Giving GPs power over commissioning would allow family doctors to either change them or put pressure on those services to improve, he said.

‘Changes are like jumping off a cliff’

YORK University’s Professor of Health Economics Alan Maynard despairs that a year into the coalition Government, the NHS is again facing massive reorganisation.

Prof Maynard said: “I think it is most unfortunate because so much energy in the NHS is being diverted into what I call re-disorganisation.

“In the musical chairs syndrome that is going on, we have people retiring, then setting up consultancies and coming back at a higher price.”

The York academic said there is “no evidence” to support the Government’s view that reforms will benefit the NHS.

“It is rather like jumping off a cliff and we have no evidence to show that GPs are going to be wonderful managers,” he said.

Prof Maynard said increased funding under Labour had resulted in reduced waiting times and improved performance.

But he said the next four years will see little or no increase in real NHS funding, with managers required to save £20bn by being more efficient.

Perfect storm fears for service

DURHAM University academic Professor David Hunter fears that the NHS is heading for “a perfect storm”.

The professor of health policy and management at Durham University has been very critical of Health Secretary Andrew Lansley’s radical proposals to produce a slimmed-down, GP-led NHS.

“I think the reforms have been a distraction for the NHS,” said Prof Hunter.

“The system was sorting itself out into bigger primary care clusters. We were moving towards the rationalisation of that structure anyway, we didn’t need a Big Bang.”

He fears that the pressures building up inside the NHS, as it struggles to make £20bn cuts, dismantle existing management structures and keep hitting performance targets, “has the potential to create a perfect storm which could hit patient care”.

He added: “One thing the North-East NHS has done is to develop a regional approach to health issues, such as setting up Fresh to tackle smoking and Balance to tackle heavy drinking. These regionwide entities are going to be vulnerable because of the new localist agenda.”