“The Coalition’s health reforms have been much debated this week with the launch of the Health and Social Care Bill. For all the column inches they have generated, some of the proposals build on previous reforms in an evolutionary way, and several of the key proposals are long overdue: focusing on outcomes rather than targets and promoting more effective joint working with local government, for example. Integrating public health into the broader health and well-being role of local authorities is also positive – albeit with some practical and cultural issues still to resolve.
However, the key issue has been plans to give responsibility for some £80 billion of public money to GP-led consortia to spend on the care that their patients need. In the process, we will see the abolition of many of the local and regional bodies that have previously planned and paid for our health care. All this comes at a time when need is rising rapidly, when medical costs are increasing and when the NHS has been tasked with making savings of some £20 billion (including dramatic reductions in management and admin costs). While the principle of greater clinical engagement in the running of the NHS is undoubtedly right, the issue is the pace and scale of the changes proposed. Whenever there is a major reorganisation, the evidence suggests that morale and productivity decline and that positive service development stalls – often for 18 months or longer after the changes. For this reason, changing structures (by itself) tends not to achieve stated objectives and often does not save the money anticipated. Unfortunately, the NHS has seen a series of rapid reorganisations, often meaning that new structures only just start to hit the ground running before they are reorganised again. This was recognised by the Conservatives themselves, who were initially committed to no more top-down, central reorganisations of the NHS.
While greater clinical engagement is crucial, there may be ways of trying to achieve this by evolution rather than revolution. Trying to reorganise the system, save so much money and make so many management savings at the same time seems risky – particularly as some of the changes will be just starting to take effect when the next election takes place.