06.02.15
NHS shake-up was ‘disastrous’ and distracted from patient care – report
The coalition government’s reorganisation of the NHS was misguided, leaving it weaker, structurally “incomprehensible” and less able to improve care for patients, according to a new report from the King’s Fund.
The think tank concludes that the upheaval caused by the Health and Social Care Act has been “damaging and distracting”. The analysis found that the coalition government's changes wasted three years, failed patients, caused financial distress and left a strategic vacuum.
The massively controversial reforms, spearheaded by Andrew Lansley in his time as health secretary, are roundly trounced in the report. As well as a scathing assessment of Lansley, it also accuses David Cameron of errors and allowing his health secretary at the time to press ahead with the reforms.
It is particularly critical of the decision to implement complex organisational changes at a time “when the NHS should have been focused on tackling growing pressures on services and an unprecedented funding squeeze”.
Professor Chris Ham, the King’s Fund’s chief executive, said: “Historians will not be kind in their assessment of the coalition government’s record on NHS reform. The first three years were wasted on major organisational changes when the NHS should have been concentrating on growing financial and services pressures. This was a strategic error. Only latterly has the government adopted a more positive focus on improving patient care and achieving closer integration of services. Politicians should be wary of ever again embarking on such a sweeping and complicated reorganisation of the NHS.”
The report describes an “unwieldy” structure that has emerged since the reorganisation, with leadership fractured between several national bodies, a “bewilderingly complex” regulatory system and a strategic vacuum in place of the system leadership that was previously provided by strategic health authorities.
It describes the claims of widespread privatisation as exaggerated, saying that less than 10% of the NHS budget is spent on non-NHS providers, but says the emphasis on competition has resulted in greater complexity and uncertainty about when contracts should be put out to tender.
Despite the intention to devolve decision-making and reduce political interference, the authors found that the period since the Act was implemented has been characterised by regular ministerial intervention and a continued focus on targets.
It is also critical of NHS England, saying that it has been slow to establish itself, mainly due to its wide-ranging responsibilities. Meanwhile, responsibility for commissioning has been fragmented between different bodies.
The report highlights a significant change in the coalition's approach to the NHS, with the second half of the parliament characterised by a welcome shift away from the technocratic changes contained in the Health and Social Care Act to concentrate on safety and quality of care.
It says ministers have turned their attention away from competition and choice to focus on regulation and transparent reporting of performance data to improve care standards. The report argues that the next government should build on this with less emphasis on inspection and more support for hard-pressed staff to improve patient care, and accelerate moves to achieve closer integration of services.
Dr Mark Porter, head of the British Medical Association (BMA) said the changes were "opposed by patients, the public and NHS staff, but politicians pushed through the changes regardless".
He added: "This report highlights the damage that has been done to the health service and the major shortcomings of the Act, which distracted attention from rising pressure on services and cost billions to introduce.
"The damage done to the NHS has been profound and intense, but what is needed now is an honest and frank debate over how we can put right what has gone wrong without the need for another unnecessary and costly top-down reorganisation."
The Royal College of Nursing said that the “unnecessary and distracting chaos” outlined in the report echoed warnings from the College.
“It is particularly galling for patients and staff that this reorganisation cost the NHS so much money at a time when financial pressures are squeezing patient care harder than ever before,” said Dr Peter Carter, chief executive of the college.
“Future governments must learn from this debacle and stop meddling in the NHS. Concentrating on providing long-term investment in the workforce, and supporting health care organisations to work together to provide excellent patient care will go a long way towards protecting the NHS for future generations.”
NHS Confederation director of policy Dr Johnny Marshall, a practising GP, called for stability from the next government.
“The next government must avoid at all costs a top down reorganisation of NHS structures. We need to build upon the progress which is being made locally by the NHS, including by clinical commissioners, in transforming care, not waste time with any disruptive restructuring mandated by Whitehall.”
A spokesman for Jeremy Hunt said: “We welcome the King’s Fund’s recognition that the government’s focus on patient safety and integrated care is right for the NHS’ future. This independent assessment also puts paid to Ed Miliband’s myth that the reforms were about privatisation, and highlights why both the public and the health sector should be wary of Labour’s plans for upheaval and reorganisation.”
(Image source: Steph Gray)
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