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“2020health is an important and thoughtful contributor to the health debate”

Dr Sarah Wollaston MP, Chairman, Health Select Committee


PharmaTimes The NHS - reform or ruin?

With just days before the UK General Election, the NHS is at the forefront of the campaign trail and the political parties have come out sparring. Labour, it seems, is staging an all-out war, pledging to repeal the Conservatives’ Health and Social Care Act 2012 and end the alleged shift towards privatisation. The Tories, on the other hand, are remaining steadfast, reiterating the relationship between a strong economy and a strong NHS.

The premise of former Health Secretary Andrew Lansley’s reforms, introduced in April 2013, was to transfer public health from central to local government, giving clinicians greater involvement in the commissioning process through the development of clinical commissioning groups. This was set amid the stark warning from the then NHS chief executive Sir David Nicholson that the Service needed to find efficiency savings totalling £20 billion by 2015.

Needless to say, the reforms and the efficiency savings, at the same time as improving patient outcomes – all during a slow economic recovery – have been a challenge. The bill for the mass reorganisation has topped £3 billion and critics (notably Labour) claim patients are now worse off; citing missed waiting targets, A&E problems, drops in performance and continuous budgetary issues. A survey of health staff last year by Dods Parliamentary Communications found just 5% of healthcare professionals believe the reforms have had a positive impact. Even senior Tories have publicly admitted the NHS reforms have been the government’s biggest mistake. But is it better to stick with these reforms rather than create yet more upheaval for the Service by instigating further change? Opinion, it seems, is divided.

“The reforms were undemocratic, unnecessary and unwanted,” claims Clive Peedell, co-leader of the National Health Action Party, General Election candidate in Witney and consultant oncologist. He believes the Act was legislated for a regulated economic external market designed to “increasingly dismantle and privatise large sections of the NHS” and remove the responsibilities and duties of the Secretary of State for Health. “This is now creating chaos, confusion and fragmentation at the frontline,” he says.

The reforms have also been a massive distraction, says Gail Beer, director of operations at 2020Health. “We have spent a lot of time arguing over them and this has distracted people from getting on and discussing the big issues – what we can afford, if we want it how are we going to pay for it, and how we should be delivering care in the digital age.”

But Beer also says it is wrong to suggest that everything about the reforms is bad. For instance, the focus on public health and local services and solutions “is something positive to build on”, she says. This is echoed by Andrew Hine, head of UK healthcare at KPMG, who adds that the reforms have enabled a significant reduction in management costs and created a stronger focus on primary care and decision making by GPs. “Overall the reforms have been beneficial,” he says, “but at a considerable cost both financially and in time lost during the change process”.

Labour has publicly shunned the reforms and centred its election campaign around repealing the reorganisation and “calling time on the market experiment”. “If the NHS is to reshape services for the 21st century – and make them financially sustainable – it must have full permission to collaborate and integrate without being trapped in the red tape of compulsory tendering,” Shadow Health Secretary Andy Burnham told PharmaTimes Magazine. He is adamant the market is not the answer to 21st century care, citing evidence from other countries that suggests market-based health systems cost more.

The NHS did not need reorganising, he says – nor does it need new organisations for the changes that ‘whole person care’ could make possible under a Labour Government, he adds. Supposedly his proposals “would not result in another damaging reorganisation like the past few years”. Focussing on home care, integrated social care and prevention – funded through a mansion tax, a tax on tobacco firms and a clamp down on tax avoidance – Burnham pledges to work with the bodies Labour inherits, if it were to win the election, simply by asking them to work together in a new way.

But not everyone is as positive about Labour’s scheme. While Burnham says Labour’s plan for the NHS has been presented in “unprecedented detail before people vote”, some commentators say there is still a lack of clarity and vision around what exactly the party will implement and how far the repeal goes. Beer, for one, fears the distraction that will come from further reorganisation, Hine notes that any more reform will still result in substantial costs, while the ABPI has categorically opposed Labour’s plans, saying this will lead to uncertainty that will not be welcome.

The repercussion of any change on the quality of services and patient care is where parties should be directing their attention, says Paul Briddock, director of policy at the Healthcare Financial Management Association. Any reform, by Labour or others, he says, needs to avoid diverting attention away from what matters most: increasing quality and decreasing costs. Indeed, this is the argument the Conservatives are zoning in on as they attack the opposition’s plans. Says Health Minister George Freeman: “The question for Labour is: how will their plans actually help the NHS deal with the challenges it faces in the years ahead?”

And these challenges are plenty. Each party thinks its plans are the silver bullet but, as Beer points out, no one has actually asked the public how they would like the NHS shaped. For all intents and purposes, the parties’ propositions are still very much top-down approaches. Furthermore, the issue on what the NHS can afford and how it will be funded in the future remains the elephant in the room.

The fact is the NHS is fundamentally in distress – and no amount of blaming the situation on past governments is going to provide a solution for the future. Yet the debate will go on and opinions will differ over what the best course of action is, whether it’s bed in the Tories’ changes, mere tinkering or outright reform.

Perhaps ironically is the realisation that, regardless of which side of the fence the parties sit on, further reform on some level will be inevitable – whoever comes to power. Doing things the same old way just isn’t an option, notes Beer. The impact of new technologies, greater public engagement and rising consumer expectations will mean the demands on healthcare in the future will be very different, she says. And money – even if it was available – isn’t the answer, adds Briddock.

The only solution, really, is change. It’s up to the politicians to adequately manage that. Indeed, as Briddock notes: “Whichever party is elected, it will have its work cut out when it comes to the NHS.”