Government leader admits NHS reforms ‘risk’ creating a postcode lottery

Matthew Kershaw, chief executive of Salisbury NHS Foundation Trust and director of provider delivery at the DH, was speaking at the Innovation Expo 2011 in London earlier this week.

Quizzed by BBH editor, Jo Makosinski, about the impact of the proposed GP commissioning system, he said: “There is a risk that people will make very different decisions and build services very differently across the country.”

There is a risk that people will make very different decisions and build services very differently across the country

His admission came as he provided more detail about how the new provider landscape would work if the Health and Social Care Bill is passed.

And he revealed that foundation trusts (FTs), including major hospitals, could, in some cases, refuse to provide certain treatments, an issue that has been widely criticised amid fears patients will have much longer waits for more-costly treatment.

Kershaw said: “If services are not designated as essential services, FTs will be able to say they are not providing them. If the services are designated as essential, they won’t be able to say that. The key is in what is designated and what is not, and that will be linked into new Monitor and GP commissioners.

“Providers are not going to have the final say, but they will have involvement. I envisage things will be different throughout the country. For example, in London, where there’s lots of choice, it will be very different to more remote places where there is less choice.

“There is a risk [of a postcode lottery], but I think that is unlikely to happen. We still expect a broad range of services to cover the whole of the country.”

If services are not designated as essential services, FTs will be able to say they are not providing them. If the services are designated as essential, they won’t be able to say that

Commenting on claims that existing providers could team up and prevent the competition the Government is hoping for, he added: “Providers can’t just divvy up services and prevent competition, but they also can’t be told they cannot speak to each other at all because that will create a whole raft of unsustainable services. That will not be allowed to happen. There will need to be judgements taken about where the balance is struck, but at the moment it’s not properly known. That is the whole point of the reforms, to encourage new entrants.”

He said the new-look Monitor would be responsible for encouraging competition and there would be a regime for services that are unsuitable or failing.

“The protection of services is crucial and if they fail they will need to be provided by somebody else,” he added. “There will be a regime in place for unsustainable services to protect parts of the country so that provision is maintained at all times.”