:00:14. > :00:18.I'm Gerry Robinson. I have been in business all my life. I have turned
:00:18. > :00:22.around failing companies, and I've managed billion-pound budgets.
:00:22. > :00:28.Three years ago I spent months inside a hospital for a BBC series
:00:28. > :00:38.trying to work out how to make the NHS run more smoothly. Now, as it
:00:38. > :00:42.faces its biggest transformation Since the Government announced the
:00:42. > :00:46.Health and Social Care Bill last year, there's been fear and anger
:00:46. > :00:49.amongst the public about where our Health Service is headed. If you
:00:49. > :00:55.have money driving your decisions, they won't be the best decisions
:00:55. > :01:00.for the patients. The reforms aim to save �20 billion over three
:01:00. > :01:06.years, but are GPs the right people to put in charge? What
:01:06. > :01:09.qualifications do people have to manage something of that scale?
:01:09. > :01:12.What qualifications do you have to... That's an extremely good
:01:12. > :01:16.question and one that I often ask myself in the middle of the night
:01:16. > :01:20.when I'm not sleeping very well. I'll find out where our Health
:01:20. > :01:25.Service is failing... So you think procedures are happening either
:01:25. > :01:31.carelessly or deliberately that don't... Deliberately. That don't
:01:31. > :01:35.need to happen? Correct. I meet the man who is staking his political
:01:35. > :01:38.reputation on these reforms. We've opened the Pandora's box, you know.
:01:38. > :01:48.Every worry about the NHS is now coming in to be part of the
:01:48. > :01:50.
:01:50. > :01:56.question of how do we deal with it I've never seen an organisation
:01:56. > :01:59.like the NHS, as dysfunctional as it is loved. I don't know what
:01:59. > :02:03.these reforms are going to do to the Health Service, so I think it's
:02:03. > :02:06.important that I get out there and meet the people who, you know, when
:02:06. > :02:10.the dust settles are going to have to put these reforms into practise.
:02:10. > :02:15.As the Government's health reforms have generated debate, I have been
:02:15. > :02:19.travelling around the country to form my own view on the Bill. I
:02:19. > :02:23.think these plans have been very poorly communicated. It's -
:02:23. > :02:25.everyone is confused by it, and that confusion is simply not
:02:25. > :02:30.helpful. Despite the Government's listening exercise as the Bill goes
:02:30. > :02:34.back to Parliament, the key aims remain the same, from what I can
:02:35. > :02:37.see - most important is a bigger role for GPs. They'll be at the
:02:37. > :02:41.heart of the new bodies that will replace Primary Care Trusts in
:02:41. > :02:45.making decisions on behalf of us, the patients.
:02:45. > :02:51.And there's one GP who our Prime Minister wants us all to know is
:02:51. > :02:58.right behind the plans. Calm down, dear. Calm down. Calm down.
:02:58. > :03:00.LAUGHTER Listen - calm down and listen to
:03:01. > :03:03.the doctor. Howard Stoate GP a says this, "My discussions with fellow
:03:03. > :03:06.GPs reveal overwhelming enthusiasm for the chance to help shape
:03:06. > :03:11.services for the patients they see daily."
:03:11. > :03:15.Will you tell me how you have been, George? Fine, absolutely fine. I
:03:15. > :03:19.have been having physiotherapy, physiotherapy treatment. Tell me
:03:19. > :03:24.how you found the physiotherapist? Very good indeed. Howard Stoate has
:03:24. > :03:29.been a GP for 29 years and was a Labour MP for 13 of those. Here in
:03:29. > :03:39.the commuter belt of Bexley, the PM's poster boy for the reforms and
:03:39. > :03:39.
:03:39. > :03:45.his fellow GPs have had control over patient care since 2008.
:03:45. > :03:50.morning, Gerry. Welcome to the Albion. How does it work in
:03:50. > :03:54.practise? Instead of GPs saying what services are available to this
:03:54. > :03:58.patient, and say this hospital provides this service that hospital
:03:58. > :04:03.provides that service - that's actually - we think - the wrong way
:04:03. > :04:06.around. If you start with a blank piece of paper, how would you best
:04:06. > :04:09.design a service, not pick a service off a menu of a service
:04:09. > :04:15.that exists, - how would you design a service from scratch that meets
:04:15. > :04:19.the patient's needs, and you start from there. The NHS budget for,
:04:19. > :04:21.butly alone is �350 million a year, and up till now, while GPs here
:04:21. > :04:23.have been making the decisions, the Primary Care Trust has still been
:04:23. > :04:25.signing the cheques. In future, Clinical Commissioning Groups led
:04:25. > :04:28.by GPs like Howard will control the money.
:04:28. > :04:33.I have managed budgets of this size, and I know what it requires. I
:04:33. > :04:38.can't help wondering if GPs are the right people to take control.
:04:38. > :04:42.What qualifications do people have to manage something of that scale?
:04:42. > :04:45.What qualifications do you have to - to... That's an extremely good
:04:45. > :04:51.question, and one I'll ask myself often in the middle of the night
:04:51. > :04:54.when I'm not sleeping very well because it is a great concern to me.
:04:54. > :04:57.What I would say in my defence is that GPs are very good at what GPs
:04:57. > :05:00.do. GPs are very good at understanding patient needs. GPs
:05:01. > :05:10.are very good at talking to their patients to know exactly what their
:05:11. > :05:11.
:05:11. > :05:14.needs are. To prove to me just how well GP commissioning can work,
:05:14. > :05:16.Howard sent me to look at a local cardiology scheme that's won
:05:16. > :05:18.countless awards. It's the brainchild of one of Howard's
:05:18. > :05:20.colleagues who felt his local hospital had him and his heart
:05:20. > :05:25.patients over a barrel. When we tried to get a breakdown of
:05:25. > :05:29.the Bill we used to get for cardiology, it took us 18 months to
:05:29. > :05:33.find out why we're paying the money. GPs should have the power to look
:05:33. > :05:39.at the books and see where every penny of taxpayers' money is going
:05:39. > :05:41.to. Kosta used to refer his heart patients to his local hospital,
:05:41. > :05:46.where consultants usually ordered an angiogram, an expensive,
:05:46. > :05:52.sometimes painful, test where dye is injected into a vein.
:05:52. > :05:59.So Kosta used his new commissioning power to bypass the old system. Now
:05:59. > :06:02.he has a top cardiologist from a London teaching hospital come to
:06:02. > :06:07.Bexley to examine his patients on the spot and decide what tests are
:06:07. > :06:10.needed. It's meant fewer costly angiograms, but that's not the only
:06:10. > :06:17.change. When the consultant sees the patient, he decides whether he
:06:17. > :06:22.needs further investigations, and if he needs angiography, instead of
:06:22. > :06:28.sending them to the hospital, he sends them to Harley Street with
:06:28. > :06:31.the transport provided by the service. Welcome to the weekly
:06:31. > :06:35.heart bus to Harley Street courtesy of Kosta. I caught the bus to meet
:06:35. > :06:39.the specialist who decides who gets on - cardiologist Dr David Brennand
:06:39. > :06:46.Roper. He's convinced the scheme's better for the patients and better
:06:46. > :06:51.for NHS finances. When they analysed the costs of sending a
:06:51. > :06:54.patient to the chest clinic, they found that the average saving
:06:54. > :06:59.versus the average cost of a journey through the hospital
:06:59. > :07:08.including various tests, they saved about �1,000 a patient.
:07:08. > :07:12.So what do the patients make of it? Are you surprised to be going to
:07:13. > :07:16.Harley Street or not on the NHS? It's a nice surprise. I didn't
:07:16. > :07:18.expect that I was going to Harley Street, but yeah, it will be
:07:18. > :07:26.interesting. And there's also bonus for patients like Angela. Unlike
:07:26. > :07:29.the hospital, the Harley Street clinic has a high-tech low-
:07:29. > :07:36.radiation CT scanner which makes invasive angiograms unnecessary.
:07:36. > :07:39.I'm just going to move you into position. The clinic's scanner can
:07:39. > :07:42.scan a heart in a single heartbeat while giving a fifth of the
:07:42. > :07:46.radiation dose of Angela's local hospital version. But it means NHS
:07:46. > :07:49.revenue going out of the system to a private provider simply because
:07:49. > :07:51.they've got better kit. I don't really understand why we
:07:51. > :07:54.can't have similar facilities available within local hospitals
:07:54. > :07:59.within local hospitals within the NHS itself. We spend �100 billion a
:07:59. > :08:02.year on the NHS. A few million here or there is hardly noticeable.
:08:02. > :08:07.Savings could be made in other territories. It seems to me
:08:07. > :08:10.extraordinary that we haven't got more of them because we're still
:08:10. > :08:15.sending patients for these unpleasant angiograms when this it
:08:15. > :08:21.can is available to do it a lot more pleasantly.
:08:21. > :08:26.For the hospitals, it might be worse than just having inferior kit.
:08:26. > :08:29.The way they process heart patients might need examination too. With
:08:29. > :08:33.the transparency that's come with gaining control of patient care,
:08:33. > :08:36.Kosta claims to have found some alarming hospital practise. He
:08:36. > :08:40.believes angiograms were routinely ordered at the local hospital
:08:40. > :08:44.partly because they're a source of income. You know full well that
:08:44. > :08:48.that bill is artificially boosted. So you think procedures are
:08:48. > :08:53.happening either carelessly or deliberately that... Deliberately.
:08:53. > :08:57.That don't need to happen? Correct. Angiograms - they used to do
:08:57. > :09:01.angiograms in your local hospital. And when you look at the figures,
:09:01. > :09:05.500 angiograms of which 180 were actually necessary. The rest was
:09:05. > :09:10.just to create revenue. So when - when we talk about the potential
:09:10. > :09:14.for saving, you think there's a huge potential for saving in the
:09:14. > :09:19.NHS... Billions. Without harming the patient? Yes. The Secretary of
:09:19. > :09:23.State for Health and architect of the new reforms, Andrew Lansley,
:09:23. > :09:27.agrees with Kosta that the current system can encourage this sort of
:09:27. > :09:30.wastage. Well, it can happen, and it happens because of the way the
:09:30. > :09:34.payment system in the NHS works at the moment because it pays for
:09:34. > :09:37.activity so, of course, if you incentivise somebody just to do
:09:37. > :09:41.more work, they'll do more work. What I'm talking about is us
:09:41. > :09:44.getting to the point where what the payment system focuses on is
:09:44. > :09:49.delivering quality and the results for patients, and that's a
:09:49. > :09:54.different matter, of course. Currently, PCTs pay hospitals a set
:09:54. > :09:57.tariff for most of the procedures they carry out, so if hospitals
:09:57. > :10:03.aren't rigorous in weeding out anything unnecessary, the potential
:10:03. > :10:07.for waste is huge. The South London Healthcare Trust
:10:07. > :10:14.told us they refute the allegation that unnecessary angiograms were
:10:14. > :10:16.carried out, and at the time, coronary angiography was an
:10:16. > :10:20.accepted normal investigation for suspected heart disease throughout
:10:20. > :10:25.the UK. The Trust is working closely with local GPs to continue
:10:25. > :10:31.to improve services. Back in Harley Street, it's good
:10:31. > :10:36.news for Angela. Her scan is clear. If this scheme is anything to go by,
:10:36. > :10:41.then clearly GPs are likely to go private if they feel their local
:10:41. > :10:44.NHS services are inefficient. The reforms have been changed so that
:10:44. > :10:48.private providers can't undercut NHS rates, so they'll have to win
:10:48. > :10:54.on quality, not price. That seems pretty straight forward.
:10:54. > :10:59.Yes. But it's still attractive to those like Paul Jenkins who runs
:10:59. > :11:04.the Harley Street Clinic. Does the opening up of the central
:11:04. > :11:07.- or the attempt to open up the NHS - does that represent a business
:11:07. > :11:10.opportunity for you? Yes, I think it does because we have
:11:10. > :11:16.demonstrated with this project with Bexley that the model works, and
:11:16. > :11:20.we're very keen to expand it to other, you know, care trust GPs,
:11:20. > :11:24.commissioners, and in discussions with a number of them. Even Howard
:11:24. > :11:27.Stoate, who is a fan of GP commissioning, has concerns for how
:11:27. > :11:37.local hospitals will fare in the brave new world. What happens if a
:11:37. > :11:40.local hospital can't or won't or is for whatever reason not able to
:11:41. > :11:46.deliver the service the GPs decide to buy, and they are forced to go
:11:46. > :11:50.to other providers because there is no alternative? Now, that's the
:11:50. > :11:57.controversial bit. So will hospitals need to close? And if
:11:57. > :12:01.they do, who makes the decision? What it means is that may be
:12:01. > :12:06.significantly fewer people in hospital beds. There may still be
:12:06. > :12:10.very much, you know, visiting their hospital for the outpatients'
:12:10. > :12:14.appointment visiting their hospital for diagnostics, visiting their
:12:14. > :12:19.hospital as a day case. Now, all of those things means hospitals change,
:12:19. > :12:23.of course it does. It doesn't mean they necessarily close. If it does
:12:23. > :12:29.need those decisions to be made about hospital closures, who will
:12:29. > :12:33.make those decisions? But you don't. You don't in the business world.
:12:33. > :12:36.You don't. You need to decide, you know, how many stores you're going
:12:36. > :12:44.to have on the basis of somebody sitting there with you in - you
:12:44. > :12:48.know, head office with a big map moving things around. You do. You
:12:48. > :12:53.got three Tesco stores within - and one of them is not working. You
:12:53. > :12:56.don't - you certainly don't build another one, and you certainly
:12:56. > :13:02.close one. If the people who are commissioning the service want the
:13:02. > :13:06.service to be there, if the public want the service to be there, if it
:13:06. > :13:10.is transparent that the service is in demand it doesn't make sense to
:13:10. > :13:15.shut it down. But the reality is that not all GPs
:13:15. > :13:19.are happy with what their hospitals are providing, and I feared for
:13:19. > :13:21.some hospitals. For me it was the first sign that GP reform would
:13:21. > :13:31.affect the rest of the NHS especially if no-one is managing
:13:31. > :13:34.
:13:34. > :13:37.from the centre, so how will it affect patients? Like the I -- I
:13:37. > :13:42.travelled from Bexley to hackney East London, one of the country's
:13:42. > :13:46.poorest neighbourhoods and home to Dr Deborah Colvin's practise. If
:13:46. > :13:50.you have money driving your decision, they won't be the best
:13:50. > :13:54.decisions for the patients. If we agree together as a society, OK.
:13:54. > :13:58.These are the outcomes we want. Let's get together and work out how
:13:58. > :14:02.to make them happen, then people will be driven by wanting to do the
:14:02. > :14:07.best for the patient. Like the heart scan project, the GPs here
:14:07. > :14:10.have devised a scheme that joins up a lot of agencies really
:14:10. > :14:15.effectively. It's for patients with diabetes. But unlike the Bexley
:14:15. > :14:18.doctors, in Hackney, they're keeping it all within the NHS.
:14:18. > :14:22.beauty of the scheme is that diabetes is a complex illness, and
:14:22. > :14:26.there are lots of problems, and you need lots of people working
:14:26. > :14:29.together, and if you can bring everybody together, you can work
:14:29. > :14:33.out the best path for them because everybody's different. What works
:14:33. > :14:38.for one person doesn't work for another. Central to the new reforms
:14:38. > :14:42.is patient choice - the mantra is, "No decision about me without me."
:14:42. > :14:52.But for Deborah, the choice between private provider and NHS could
:14:52. > :14:55.
:14:55. > :15:00.If she said I want to see a dietician from this company and a
:15:00. > :15:03.nurse from that company, it would make my life a nightmare.
:15:03. > :15:05.Contacting different people, different payment systems, forms,
:15:05. > :15:09.phone numbers. I would never get everybody together to talk together.
:15:09. > :15:12.If the service wasn't working for me then, I would need to sit down
:15:12. > :15:16.with the people that were working with me and then we could discuss
:15:16. > :15:23.what was going wrong. I wouldn't just necessarily come out and say,
:15:23. > :15:31.well, I need to change this service. In a sense, the informed choice,
:15:31. > :15:35.whether we like it or not, it's true for me, has to be made by the
:15:35. > :15:39.medical expert. I think Debra is really impressive. She's totally
:15:39. > :15:43.committed to doing the right thing for her patients and totally
:15:43. > :15:47.committed to doing it within the health service. She's not happy
:15:47. > :15:51.with outside providers. I've got some sympathy with that. There is a
:15:51. > :16:00.place for outside providers, but it needs to be very, very carefully
:16:00. > :16:05.managed. Private health care providers come from a wide and
:16:05. > :16:12.varied background. Circle are one of them. They run three hospitals
:16:12. > :16:16.already and plan to open another 25. Ail Parsa, a former Goldman Sachs
:16:16. > :16:19.investment banker, is their co- founder. Do you think that these
:16:19. > :16:27.changes will present an opportunity for the private sector to come in
:16:27. > :16:29.and do things, make things happen? Yes, I do. I think that it's health
:16:29. > :16:33.care professionals, social entrepreneurs, they will come up
:16:33. > :16:39.with new ideas, new solutions. Web those ideas and solutions will only
:16:39. > :16:45.work if patients choose to go there. He passionately believes private
:16:45. > :16:53.providers will improve the NHS. years ago we used to spend �37
:16:53. > :16:57.billion in health care. Today we're spending 127 billion in health care.
:16:57. > :17:00.We tripled the cost of delivery. This country can't afford three
:17:00. > :17:07.times as much in another ten years. We need to look at different
:17:07. > :17:11.solutions. The solution being proposed now is that patients will
:17:11. > :17:17.choose their own treatments from a list of qualified providers, NHS
:17:17. > :17:21.and private. That makes the NHS lift its game. To me, this is a
:17:21. > :17:25.total cop-out. Get the system better with management not with the
:17:25. > :17:28.threat of outside providers. I have absolutely no objection to using
:17:28. > :17:34.outside providers and I've no objection to their making a profit.
:17:34. > :17:38.What I hate is the idea of using outside providers as a way of, you
:17:38. > :17:41.know, making efficiency changes in the health service itself. That's
:17:41. > :17:45.straightforward cowardlyness. If there are savings to be made within
:17:45. > :17:49.the health service, it needs to be managed within the health service,
:17:49. > :17:52.by a central system, which sets out what it wants in a strategic way
:17:52. > :18:01.and follow it's through. It's cowardly. It's wrong. It doesn't
:18:01. > :18:05.actually work. It ends up destroying the organisation itself.
:18:05. > :18:09.I have a strong sense that you're trying to use external competition
:18:09. > :18:14.to make the internal market or the internal service work better.
:18:15. > :18:19.really. My experience of the NHS is actually there is more than
:18:19. > :18:28.sufficient competence, enterprise, innovation in the service. We just
:18:28. > :18:34.have to let it out. Back in May, when the reforms were
:18:34. > :18:39.being debated, the anger out there was incredibly powerful. Do you see
:18:39. > :18:45.this as the beginning of the end of the NHS, do you? I think it's just
:18:45. > :18:48.going to be a brand, a logo, stuck onto a corporate machine,
:18:48. > :18:52.disgusting. These measures affect everyone in our society and the
:18:52. > :18:57.people who are making them and the people who can afford them with
:18:57. > :19:04.private health care, that's fine for them.
:19:04. > :19:11.I think the NHS stands for something quite important. It
:19:11. > :19:17.unites everyone in this country, the NHS. We all have this amazing
:19:17. > :19:21.access to health care. The NHS has been described as the closest the
:19:22. > :19:26.British have to a religion. Many here clearly believe what's
:19:26. > :19:30.proposed is sacrilege. If you're going to change the NHS you need to
:19:30. > :19:36.do it extraordinarily carefully. And the feeling here is that
:19:36. > :19:40.actually this is the beginning of the end. People find change
:19:40. > :19:44.incredibly difficult. Sometimes they have concerns and they want to
:19:44. > :19:48.know those concerns have been heard and responded to. A lot of that was
:19:48. > :19:52.about saying, well, you know, it's going to mean privatisation of the
:19:52. > :19:56.NHS and it won't. But it wasn't about involving the private sector
:19:56. > :20:04.more. It was actually about getting the best possible services for
:20:04. > :20:08.patients. The big driver for these changes is savings. With increased
:20:08. > :20:13.demand and an ageing population, soon the NHS is simply going to
:20:13. > :20:17.cost too much money. Do you know it's horrifying how much money this
:20:17. > :20:22.organisation chews threw and ongoing it's just not sustainable.
:20:22. > :20:29.So it's vital that we make the right changes to make sure that we
:20:30. > :20:37.do have an NHS around over the coming years. It's just crucial.
:20:37. > :20:40.Near the top there. That's it. move this, does it hurt? Andrew
:20:40. > :20:46.Lansley's confident that getting rid of Primary Care Trusts will
:20:46. > :20:51.bring big savings for the NHS. Where the reforms are yet to be
:20:51. > :20:57.agreed, it's already happening. Back in Hackney, Dr Deborah
:20:57. > :21:01.Colvin's local PCT has gone, merged with two others. It's causing chaos.
:21:01. > :21:09.Things are coming apart. We don't know next month where we're going
:21:09. > :21:14.to get our IT support from, because half of it's gone, 50% of the PCT
:21:14. > :21:18.have gone. She took me to her derelict old PCT building. Some of
:21:18. > :21:27.the team were moved from here. But many have been made redundant.
:21:27. > :21:31.Horrible, isn't it? Yes. Those teams don't exist any more and all
:21:31. > :21:36.their memories, all their knowledge of the local area and what patients
:21:36. > :21:40.need and how things work and Who's Who... All gone. All gone.
:21:40. > :21:46.It's estimated that 20,000 redundancies will occur, as PCTs
:21:46. > :21:50.are dissolved at a cost of �1 billion in redundancy payments.
:21:50. > :21:54.I've been involved in any number of changes in large organisations, but
:21:54. > :21:58.this is easily the strangest one that I've ever seen. It's already
:21:59. > :22:03.started. People are being made redundant. Things are changing, but
:22:03. > :22:07.we don't actually know what the end game is. And there's another worry
:22:07. > :22:12.about these reforms, in order to run the commissioning process
:22:12. > :22:16.effectively, GPs are going to have to band together into bigger units.
:22:16. > :22:22.Does that mean we risk losing something special about our GPs?
:22:22. > :22:27.Tuck add way in the Lincolnshire Wolds, I meet Ajay Vora, a country
:22:27. > :22:32.doctor with a thriving practice. Nice to meet you. Welcome to the
:22:32. > :22:37.practice. Thank you. Essentially a single handed practitioner, but
:22:37. > :22:43.we're in a rural area, covering approximately 100 square miles. I
:22:43. > :22:47.work with my wife, who's a nurse practitioner. It's very much a
:22:47. > :22:51.couple-driven practice. We've been here 20 years. We hopefully have
:22:51. > :22:55.got to know our patients very well. I'm excited that I might now, forts
:22:55. > :23:01.first time, have a say in how some of these funds are directly spent.
:23:01. > :23:11.Tell me the patient we're going to see? It's a lady who is house bound
:23:11. > :23:12.
:23:12. > :23:18.now. He took me on a home visit to meet one of his patients. How long
:23:18. > :23:23.is it since you had the fall? when the snow was on the ground.
:23:23. > :23:28.couple of months. When you hear all this stuff about the NHS not
:23:28. > :23:35.working well and all the reforms, what does it make you think? Well,
:23:35. > :23:40.first of all, how fortunate we are to not have the problem. You can
:23:40. > :23:46.hardly believe that they can ring up to make an appointment and being
:23:46. > :23:50.told that we can't see you for a week. When we go to our doctor, we
:23:50. > :23:58.don't get that. Somebody will always see you. It's been nice
:23:58. > :24:04.seeing you Joyce. Yes, I'm pleased to see you.
:24:04. > :24:08.Some independent GPs like Ajay also have concerns. They will be asked
:24:08. > :24:13.to join with local practices to commission as a unit. Where he now
:24:13. > :24:20.has sole control of his budget, he will find himself part of a large
:24:20. > :24:23.group having to make joint decisions. I'm told I have to refer
:24:23. > :24:27.Pat to a certain hospital with a certain consultant because a
:24:27. > :24:30.contract has been put in place that make it's work better, maybe
:24:30. > :24:35.financially. Suddenly now, she doesn't know whether I'm saying
:24:35. > :24:41.that because there's a background motive or because it is the best
:24:41. > :24:46.for her. Now there's doubt put in a patient's mind. I really think he's
:24:46. > :24:51.right. There is a danger that the purity of that patient -GP
:24:51. > :24:55.relationship could be threatened by a financial motive injected into
:24:55. > :24:59.the decision-making process. What really concerned me was who was
:24:59. > :25:02.going to manage and coordinate these GP commissioning groups. I
:25:02. > :25:05.can understand why the power to commission has been centred around
:25:05. > :25:10.GPs. I think it makes a lot of sense, these commissioning groups.
:25:10. > :25:16.But you know, who will hold the commissioning groups responsible?
:25:16. > :25:20.This lack of accountability, which to me, has never been in the NHS,
:25:20. > :25:27.isn't in the NHS and I see nothing in these reforms that will change
:25:27. > :25:31.that. There's got to be a set of people in each part of the country
:25:31. > :25:35.who are responsible. That's for clinical commissioning groups.
:25:35. > :25:38.There is a line, the NHS commissioning board is responsible
:25:38. > :25:43.for allocated resources. They're accountable to the public through
:25:43. > :25:48.the Secretary of State who sets a mandate for the ambitions for the
:25:48. > :25:53.service as a whole. These reforms affect only England. In Scotland,
:25:53. > :25:59.they're moving in the opposite direction. I headed 400 miles north
:25:59. > :26:02.to Glasgow, where they have health boards, instead of PCTs and trusts.
:26:02. > :26:11.Here hospitals and GPs work together much more closely and
:26:11. > :26:15.there is a central report ing structure. Lovely to meet you.
:26:15. > :26:17.Margaret McCartney's practice is in the west of the city. She is
:26:17. > :26:21.genuinely worried for her colleagues across the border.
:26:21. > :26:24.have a sense of impending doom. What's happening in England is
:26:24. > :26:29.horrendous. I do not see any way that patients are going to get a
:26:29. > :26:32.better deal out of this. I think doctors are going to be moved to
:26:32. > :26:36.doing more management, accountancy. Their best interests should be
:26:36. > :26:39.served by the patient in front of them. It's placing doctors in an
:26:39. > :26:43.untenable situation where the patient in front of them is going
:26:43. > :26:46.to be thinking, "Is my doctor deciding not to give me this
:26:46. > :26:50.because there's no evidence for it or because they're not willing to
:26:50. > :26:54.fund it?" On my journey round the country, I've met believers in
:26:54. > :26:58.these reforms and been convinced by them that GPs are probably the best
:26:58. > :27:04.people to handle commissioning. I've also met doubters, deeply
:27:04. > :27:09.worried about the role of private providers and I share their concern.
:27:09. > :27:17.And those who simply aren't sure what the reforms will lead to. I
:27:17. > :27:20.think the stakes here are huge, the very existence of the NHS could de-
:27:20. > :27:25.- depend on getting this right. Who's managing that big picture?
:27:25. > :27:29.For me, that's the question that remains. Unless somebody really
:27:29. > :27:33.does grab this thing at the centre and actually have the courage to
:27:33. > :27:38.make the decision that's are right, but unpopular, I think it could be
:27:38. > :27:41.the end of the NHS. This is my view, but the Health
:27:41. > :27:46.Secretary disagrees, believing the reforms will ensure the NHS is safe
:27:46. > :27:49.in his hands. With a service the size and
:27:49. > :27:53.significance of the National Health Service, you've got to take people
:27:53. > :27:56.with you. You've got 50 million patients who, for whom it's always
:27:56. > :28:00.going to be an important thing. They've got to know that, where
:28:00. > :28:03.they hear noise about is the service going to be fragmented, is
:28:03. > :28:06.it going to be safe in the future? They need to know it's going to be
:28:06. > :28:10.safe. They need to know that the people who work in it are confident
:28:10. > :28:14.it will deliver a better service in the future. I think everyone wants
:28:14. > :28:18.the health service to survive these reforms. If I've taken one thing
:28:18. > :28:21.from my journey, it's that the British love affair with the NHS is
:28:21. > :28:29.alive and strong. I just hope that these changes aren't the end of the
:28:29. > :28:32.affair. Next week on Panorama, remarkable