A major assessment of the coalition government’s record on NHS reform by The King’s Fund concludes that the upheaval caused by the Health and Social Care Act has been ‘damaging and distracting’.
The new report, The NHS under the coalition government’: Part one: NHS reform, highlights ‘some positive developments as a result of the Act’, including closer GP involvement in commissioning services, giving local authorities responsibility for public health, and the establishment of Health and Wellbeing boards. However, it criticises 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’.
Other key findings are that:
- an ‘unwieldy structure’ has emerged, ‘with leadership fractured between several national bodies’, a ‘bewilderingly complex’ regulatory system, and ‘a strategic vacuum in place of the system leadership previously provided by strategic health authorities’;
- while claims of widespread privatisation are ‘exaggerated’, 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, since the Act’s implementation there has been ‘regular ministerial intervention and a continued focus on targets’;
- responsibility for commissioning has been fragmented between different bodies, and NHS England has been slow to establish itself, ‘weighed down’ by its wide-ranging responsibilities;
- although not an explicit aim of the original reforms, progress has been made in developing integrated care.
The King’s Fund says the report ‘highlights a significant change in the coalition’s approach to the NHS’, with the second half of the parliament having seen ‘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’.
Chris Ham, CEO of The King’s Fund (pictured), 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 service 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.”
A second report, focusing on NHS finances and performance, will be published this month.
