The Government is asking the wrong questions on the NHS and has arrived at the wrong answers. Reform of the NHS must address three problems:
- Value for money. The NHS is one of the most inefficient health systems in the developed world.
- Flexibility. The NHS provides too much care in traditional hospitals and monopoly providers.
- Accountability. The NHS answers to Ministers and its staff rather than patients.
The Government’s have misdiagnosed the problems and presented the wrong solutions.
- It argues that management costs are too high. In fact good health systems depend on good management. The real inefficiency in the NHS is elsewhere.
- It argues that the “front line” of NHS services should be protected from change, in particular the “front line” of services and hospitals. In fact the “front line” accounts for over 80 per cent of NHS staff and hospitals account for around 60 per cent of the budget. “Protecting” these areas amounts to a veto on any real change at all.
- Having been in support of competition, it is now arguing that competition and the private sector can undermine services as much as improve them. In fact the current public sector monopoly is as much a threat to performance and value in the NHS as elsewhere in society.
- It argues that the NHS should be made accountable to three groups: GP-led commissioners, local government and the Department of Health. In practice this will make it next to impossible to work out who actually is responsible for delivering better healthcare. The result will be that the Secretary of State’s role will increase as he is forced to judge between these different groups, which is exactly the opposite of the Government’s intention.
The Government has set up a listening exercise, under the Future Forum, to take soundings on changes to its reforms. The best way to amend the reforms is:
- To abandon the changes to accountability via GP-commissioners, local authorities and the National Commissioning Board. This does nothing to make the NHS more accountable to the patients.
- To regain confidence in the principle of choice and competition. These are essential to deliver both a more flexible NHS and a better value one.
- Beyond this immediate agenda, the Government should:
- Make the NHS accountable to patients by giving them genuine choice over the organisations that buy healthcare on their behalf, on the model of countries such as the Netherlands, Germany and Switzerland.
- Deliver a more flexible NHS based on competition between providers of all sectors and open to change in staffing and infrastructure.
- Deliver a sustainable NHS by combining taxpayer and private payment, again on the model of most other countries.