The NHS needs reform, but are Lansley’s the way to do it?
Tom Clougherty 3:37pm
I am in two minds about Andrew Lansley’s proposed reforms of the National Health
Service, the cornerstone of which is the transfer of commissioning responsibility from Primary Care Trusts to GP-consortia. On the one hand, the NHS desperately needs radical reform. On the other
hand, I’m not sure these are the right reforms, and I’m not sure they are sufficiently radical to deliver a real difference to patients.
Let’s start with why the NHS needs reform. Firstly, it is eye-wateringly expensive at 8.1 percent of 2010 GDP, or £120bn a year. Costs have skyrocketed since 1999, doubling in real terms in the 10 years to 2009. Over that same period, productivity fell. We are spending more and more, and getting less for our money.
The latest research from the Adam Smith Institute, which analyzes World Health Organization data, suggests that the NHS fails to distinguish itself on either health outcomes or value for money – when ranked against similar countries, the UK is in the lower half of both league tables. Even more depressing are the findings of the annual Euro-Canada Health Consumer Index, which ranks the UK 15th out of 18 Western European countries in terms of healthcare performance from the perspective of the consumer. Such findings surely make it hard to keep insisting that the NHS is ‘the envy of the world’.
So yes, the NHS needs reform. But are Lansley’s proposals the right ones? Here the picture is more mixed. It is true that as well as reducing bureaucracy, the reforms should create a more bottom-up health service and encourage innovation. Moreover, previous attempts at GP fundholding suggest that it is likely to improve productivity and help to deliver better services at less cost.
That sounds quite positive, and if we were operating in a vacuum I’d say go for it. But politics being what it is, these things need to be handled very carefully. Any NHS reforms will encounter fierce resistance and drain political capital, and every subsequent failing of the health service (and there will continue to be lots of problems) will be attributed, fairly or unfairly, to those reforms. The danger is that if the benefits are not sufficiently noticeable, the very idea of public service reform will be discredited as a result.
And the trouble is, I just can’t see Lansley’s proposals delivering big, noticeable benefits. They might help a little here and there, they might be an improvement on the status quo, but they are probably not going to prove worth the effort. To put it bluntly, they don’t go far enough. They won’t help cost control in any meaningful way, because they don’t allow competition on price or abolish collective pay bargaining. They won’t do much to encourage choice or innovation, because they leave the public sector dominant and perpetuate onerous, central regulation. And crucially, they fail to put the patient in charge of their own care in any meaningful way, which is surely the key to delivering a tangible change in the patient experience.
Rather than pushing through half-baked reforms, we ought to be looking seriously at our European neighbours’ healthcare regimes, assessing what works and what doesn’t, and combining the best features of various systems to fundamentally overhaul the NHS. If such an exercise were conducted honestly, it would surely yield ideas rather different from, and infinitely more transformative than, those currently on the table. The highly successful Dutch model, with its competing insurers, private hospitals, and strictly limited role for government, provides a good starting point for discussion.
Tom Clougherty is Executive Director of the Adam Smith Institute
Previous
charles hercock
March 18th, 2011 3:48pm Report this commentSadly Lansley will destroy the coalition and lead to a Labour Government in 2015
Forget the rhetoric of the unions and doctors. All woes inevitable in a cash strapped service will be laid at Lansley's door. And then on to Cameron whose poor judgement put him there
bojimbo
March 18th, 2011 3:56pm Report this commentHe was in transport ( shadow ) for 8 years , now under health for 18 months ; what does he know about either ?
TomTom
March 18th, 2011 4:06pm Report this comment"at 8.1 percent of 2010 GDP"
Whilst not disputing any of your other points, I do not think this constitutes "expensive".
USA 14.6%; Cambodia 12%; Switzerland 11.2%; Germany 10.9%; France 9.7%; UK 7.7% according to WHO
UK is 47th in World Ranking equal with Austria but below Brazil.
I don't think our spending on Healthcare is excessive. It is remarkably cheap for employers and a main reason Social Charges are lower than in Germany or France. I do not think we should be overly obsessed with cost which is probably a bit below the level of rich countries. It is more important to focus on outputs
KP
March 18th, 2011 4:13pm Report this commentI didn't rate Lansley before the election and I rate him even less now. I think some of the reforms are good but he cannot be trusted to carry them through successfully. If Cameron wants to bring David Laws back in this role I would be happy - even if it does mean more Lib Dem cabinet members
Scotty
March 18th, 2011 4:26pm Report this commentAnother record failure of the labour gangsters - NHS not working despite massive "investment" education not working despite massive "investment" military not work, economy not working, benefits not working, pensions not working, immigration not working - despite, fill the rest in your self.
13 years of labour = nothing working.
TrevorsDen
March 18th, 2011 4:27pm Report this commentmr hercock - I think the point of this thread is that the reforms do not particularly interfere with the NHS.
The 'solution' advocated certainly would not only split the coalition it would split the tory party and its voter base and indeed the nation.
Life's easy in a think tank. The French system is massively in debt. Many cannot afford the top ups that make the German system attractive to some.
Health costs money. I am not opposed to the notion of private insurance - but given where we are its simplistic to think it can be brought in.
Laon Hulme
March 18th, 2011 4:30pm Report this commentDevolving power to 'fat cat' GPs who are themselves doing less and less for more and more money - working Monday to Friday, shut on Bank Holidays and expecting Hospital doctors to take up the slack. How can such importand decisions be devolved to "professionals" who provide part-time care to their patients then take extra money to be the GP in the Hospital out of hours clinic. This is a dumb idea. The NHS needs tweaking - not reinventing.
TrevorsDen
March 18th, 2011 5:05pm Report this commentIf you think GPs do not work hard and long hours then you are supremely thick.
Recently read an article by someone who was not particularly in favour of the reforms and whose wife is a GP - she works a 12 hr day. I can believe that, my stepdaughter is a GP.
Funny thing - people complain about 'administrators' running the NHS then when the job is given to doctors they complain as well.
Lansley was shadow health secretary for years and year and years.
Billywire
March 18th, 2011 5:33pm Report this commentDoctors,including GPs, are business people trading in health matters in the medical industry: including hard business people and people with integrity. I would expect there to be both types among GP doctors. There is a saying, "authority corrupts and absolute authority corrupts absolutely". complete authority over finances! The introduction of hard commercial businesses into the health decisions of the population by commercial consortia will tend to syphoning off NHS funds to offshore havens for maximum profit. Patients will have very little future say in health matters. Take as evidence the GPs working part time hours at present and the patient having no say in the matter. We find it very unpleasant and difficult trying to book an appointment with our GP. The latest trend to deter patients appears to be the employment of ignorant receptionists with extreme assertiveness training. Commercial groups of unaccountable doctors is a dangerous path.
lloydj
March 18th, 2011 5:45pm Report this commentTom Tom, but the 8.1% is only our public NHS cost on health what about our private sector and the subscription and perscription etc. costs?
TomTom
March 18th, 2011 6:11pm Report this commentOur private healthcare spending is tiny. Even the US spends a higher proportion of GDP on Government-funded Healthcare than Britain.
Prescription charges raise 450 million pounds...
Gabby Julie
March 18th, 2011 7:15pm Report this comment"It is true that as well as reducing bureaucracy, the reforms should create a more bottom-up health service and encourage innovation. Moreover, previous attempts at GP fundholding suggest that it is likely to improve productivity and help to deliver better services at less cost."
Actually, when fundholding was introduced, admin costs of the NHS doubled from 6% to 12% of the NHS budget. And for this latest reorganisation, we are looking at 150 odd PCTs being replaced by some 300 consortia. How do you think that is going to reduce bureaucracy?
Neither is the budget going to be handed to GPs. It is going to be handed to anyone running a GP practice. That means United Health, Atos, Assura, SERCO and the Priory Group to name but a few. Some of these already run hospitals like Circle. So if they are running GP services as well, they could be in the position where they will both be commissioning care and providing it. Now I'm not saying that they're going to be biased, but I think they might just decide that they're jolly good chaps and award themselves big health contracts. The abolition of practice boundaries also means that they won't need to take in those boring people in their area that are chronically ill and that drag the profits down. Someone's going to make an awful lot of money out of this, but it's not going to improve service or quality Tom, you are quite wrong about that.
In2minds
March 18th, 2011 7:21pm Report this commentNice opening.
ROJ
March 18th, 2011 9:36pm Report this commentFirst of all, Andrew Lansley is an over-promoted ex civil servant who should not be allowed to be in charge of the administration of a small car park.
Second, on the re-organisation of the NHS, this is clearly so desperately needed. The problem is that we are fixed in the mindset that "free at the point of delivery" must also mean a monolithic organisation, meaning "freely available at the point of delivery without any demomstration of entitlement or reimbursement".
There was a health care system before the NHS. A huge number of independent successful charitable hospitals were nationalised by Aneurin Bevan and subsumed into a centralised bureaucracy, to the everlasting detriment of their effectiveness.
An effective reform of the NHS would leave Primary Care Trusts in existence,but strip out their nonsensical "mission creep" functions, and leave them as a kind of local health insurance organisation, to "commission" ( oh, does that mean "buy") healthcare for their local population.
Anyone with experience of healthcare in other western countries would know that this is the way to go, but I really don't know why I keep bothering to comment along these lines, here and elsewhere.
And finally, Mr. Lansley's idiotic idea ( and yes John Redwood, I admit it was in the Conservative Manifesto, if you will concede that it was a couple of lines in several pages). I don't want my doctor to handle the details of how my consultant or my hospitals gets paid. I don't want him to do it personally (God forbid) and I don't want him to add admin staff to his practice to do it. I want NHS payments to consultants and hospitals to be done the way that BUPA does it. or the way It's not so hard is it? Good grief.
TomTom
March 19th, 2011 4:34am Report this comment"A huge number of independent successful charitable hospitals were nationalised by Aneurin Beva"
They were bankrupt hospitals in the main....
Mr Oulton
March 21st, 2011 11:58am Report this comment"Let’s start with why the NHS needs reform. Firstly, it is eye-wateringly expensive at 8.1 percent of 2010 GDP"
As commentators have already pointed out above - the NHS is *not* expensive. Unless of course, you're from the Adam Smith institute where almost all public spending is bad.
Why do I have to filter through so many crackpot theorists on Coffee House, nowadays? Mainly from the Adam Smith Institute. It's tiresome.
Brett Manning
March 24th, 2011 8:49pm Report this comment" it is eye-wateringly expensive at 8.1 percent of 2010 GDP, or £120bn a year"
The private US version cost nearly 30% of their GDP- why do you think this is expensive???
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