The West wakes up today to a new era in the way Government, the NHS and the benefits system works after controversial changes took effect.
The running of the grass-roots NHS – doctors, nurses, NHS care and community hospital services – have now been transferred officially to the doctors themselves in the biggest shake-up of the National Health Service since it was founded 65 years ago. And hundreds of thousands of people claiming benefit will feel the pinch from today as benefits are changed, cut, capped and reclaimed.
Doctors across the West reassured patients they should see no initial difference in the way they are treated, but the NHS reforms could radically alter how money is spent and where patients get treatment.
Gone are the old primary care trusts for Somerset, Dorset, Wiltshire, Swindon, B&NES, North Somerset, South Gloucestershire, Bristol, Gloucestershire and Herefordshire – they have now been replaced by GPs themselves.
The doctors will be getting the money for their own surgeries, and for the treatments, consultants and services they commission for their patients, direct from the Government as health ministers try to cut bureaucracy and dispense with the need for a 'middle-man' on a county or district level.
Acute hospitals like those in Bristol, Bath, Gloucester, Taunton and Swindon will still run their own affairs– they took charge of their own budgets when they became foundation hospitals in the last few years.
But GPs have banded together to form new "Clinical Commissioning Groups", along the same lines as the old PCTs, prompting criticism that it will be as bureaucratic as before. Dr Steve Rowlands, a senior GP in Trowbridge, is the new chairman of the new CCG for Wiltshire. He said the new organisation would be run very differently. "The CCG will be clinically led from the bottom up," he said.
"As GPs, we have 40 to 50 consultations a day with the public, and we listen to what they are saying and we want to improve the lot of the public.
"I'm passionate about having the right culture in the organisation where a cleaner, for example, can say to me 'I think you are wrong'. We have got very passionate GPs who want to make the NHS better. We are really lucky in Wiltshire. We have got strong local clinical practice and a group of directors who are second to none."
The new set-up increases the influence of privately-run, profit-making health businesses – the new CCGs will be expected to commission operations and treatments from places like the private hospital Circle Bath as well as from the publicly-run NHS acute hospitals.
And union leaders in the West have been battling another possible consequence of the NHS reforms – the freedom for the new NHS organisations to set their own levels of pay for staff, including nurses.
In Somerset, Bridgwater GP Dr David Rooke is the new chairman of the CCG for the county. He said the changes put power in the hands of those working in the NHS.
He said: "The new CCG role offers tremendous opportunities for clinicians and frontline professionals to have a strong leadership role, whilst at the same time working in closer partnership with patients and carers. We will empower clinicians to represent their patients and put the patients' health care experiences and journeys at the centre of our commissioning decisions."
One of the first major consequences of the NHS reforms has not yet gone to plan, however. The new CCGs across the West were supposed to have launched a new non-emergency number, 111, to replace their doctors' surgery out-of-hours number and the national NHS Direct service.
Union leaders warned that putting that service into the hands of private firms was a recipe for disaster. B&NES and Wiltshire hired one firm whose service has been deemed 'not acceptable' and the formal launch of 111 has now been delayed.
Meanwhile, the Government's changes to the benefit system have also sparked controversy. More than 20 individual changes to benefits – from a block on high-earners receiving Child Benefit to the reclaiming of housing benefit for people with a spare bedroom, dubbed the Bedroom Tax – have sparked widespread controversy.
Yesterday, Work and Pensions Secretary Iain Duncan-Smith said he would be able to live on £58 a week – prompting a Downing Street petition for him to do just that. Across towns and cities in the West, demonstrations against the benefit cuts have been held.
In Salisbury, druids from across the country, led by King Arthur Pendragon, rallied against the cuts on Saturday, while Church of England leaders have called for the cuts to be stopped.
