The Coalition’s NHS reforms reduced efficiency

Posted on April 7 2015

I campaigned long and hard against the Coalition's reform of the NHS. An academic study concluded I was the fourth most effective on line campaigner against those changes. And, I would stress, my efforts were not political, they were economically logical. 

The Coalition reforms did four things.

First they increased the number of bureaucratic organisations in the NHS needing to contract with each other. Cost increase was inevitable. 

Second, they increased the number of wholly artificial performance criteria to be used as the basis for contracting in the NHS, which was bound to reduce the effectiveness of any treatment of a person in a holistic fashion, which is essential given the co-morbidities many people face.

Third, the reforms took clinicians off front line tasks and into admin roles where they were expensive and untrained.

Lastly, a bias to private contracting that creates a silo mentality, produces a profit motive and delivers gaps in the service where disputes as to responsibility and so inefficiency was created.

It was a sorry and inevitable prospect, and now the FT has reported:

The National Health Service is facing an even bigger financial “black hole” than politicians and health leaders have acknowledged, following a sharp fall in productivity revealed in an analysis of official data for the Financial Times. 


The research, carried out by the Health Foundation, an independent think-tank, shows that despite an inflation-protected budget, hospital productivity tumbled from 2012 as the NHS prepared for, then implemented, a contentious structural shake-up that stripped out layers of management and handed budget control to clinicians.

 
In other words everything I predicted has come to pass.
 
That's hardly surprising, and nor does it suggest enormous ability on my part. I only had to look at the disastrous economics of US healthcare to make such a prediction. There twice as much of GDP is spent on health than in the UK for arguably worse health outcomes and all because of the massive inefficiency of private sector involvement.
 
So what is the answer? Glaringly obviously all health and social care services, including GP services that need to be state run, need to be integrated in single health authorities in the future. These would be local but big, so in my patch Norfolk, Suffolk, Essex and Cambridgeshire are an obvious fit, and so on. And in these areas the absurdity of contracting has to be replaced with an emphasis on holistic care, supported by the monitoring of key clinical performance indicators.
 
This is not a a panacea. But it does align service provision goals to organisation structure and it will massively reduce admin and so release resources. I hate to say it, but there is need for another NHS reform, and this time it is essential. 

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4 Responses

  1. Ian Stevenson says:
    April 7 2015 at 9:09 am

    Plain common sense, really.

  2. Mark Crown says:
    April 7 2015 at 10:38 am

    The Tories are so vulnerable on this issue yet Labour doesn’t seem to capitalise on it as much as it could.

    I wonder why? I fear that the ‘Turd Way’ element (New Labour) actually agrees with market principles in running a health service, therefore Labour is a little hamstrung about this issue because it may tacitly agree with much of it!

    Milliband should expunge the Turd Wayers from his administration and get back to basics at least on the NHS instead of making promises to individuals about waiting times. It just looks like politicians passing themselves off as management clinicians yet again.

    The NHS works. The big lie from Cameron was that he did not cut the budget for the NHS but what he also seemed to do to me was was impose yet more change and let that operational budget take the strain for the changes as well as meeting patient demand. For that alone, he should be sacked by the electorate.

    • AliB says:
      April 7 2015 at 11:42 am

      Actually the Tories did cut the budget- or rather first they gave it to the NHS then:
      1. they required billions to be transferred to Local Authorities for Social Care
      2. Georgie clawed back a significant amount of the savings the NHS had been required to make and had been promised would be reinvested in services
      3. the budget oven did not reflect actual NHS inflation which is higher because of the ageing population
      4. large amounts got diverted into the newly created admin organisations.

      • Mark Crown says:
        April 7 2015 at 1:32 pm

        I agree with everything you have said and there is some crossover with me on your point 4. So please, I’m not deluded or quoting Cameron as gospel.

        But let us be clear: he used Orwellian doublespeak. As well as promising not to cut, he also did not uprate the budgets in the sure knowledge of the effects of your points 1 to 3. So he knew it was an effective budget reduction by effect – not by input.

        So basically can we agree that concerning the NHS, our Prime Minister is indeed a liar?