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GPs go forth

'Historians will not be kind' to Government's NHS reforms, says King's Fund

The Government’s healthcare reforms have caused ‘damage and distraction’, and ‘historians will not be kind to their legacy’, a study from leading health think-tank the King’s Fund has concluded.

The think-tank criticised the timing of introducing major structural reform in 2010 when the NHS should have been focused on saving money in light of unprecedented funding pressure.

The reforms also led to a ‘fractured’ leadership structure, a ‘strategic vacuum’ in place of Strategic Health Authorities (SHAs), fragmentation of commissioning and a ‘bewilderingly complex regulatory system’.

The report, The NHS under a Coalition Government - Part one: NHS reform, said that the first half of the 2010-15 Parliament was taken up with debate about the NHS reforms, while the second part was ‘devoted to limiting the damage caused by the Bill’.

The report did highlight a number of positive developments resulting from the Health and Social Care Act, including GPs becoming more closely involved in commissioning, local authorities being given responsibility for public health, the establishment of health and wellbeing boards and progress starting to be made on integrating health and social care.

But, quoting Pulse’s 2012 article revealing GPs were outnumbered on nearly half of CCG boards, it criticised the lack of GPs on CCG boards.

The report said: ‘When CCGs were established, less than a quarter of accountable officers (who are responsible for ensuring that CCGs fulfil their duties) were GPs, and around half of CCG board members were GPs.’

The King’s Fund also criticised the emphasis on competition within the Act, which it said brought complexity and uncertainty in deciding when contracts should be put out to tender.

The other mistake of the Government was to intervene regularly in local decision-making and being too overly focused on targets, against the intended grain of the Act itself, it said.

The CQC was also criticised in the report, which said: ‘The CQC is responsible for regulating adult social care and primary medical services as well as the services delivered by NHS trusts and foundation trusts. Its work regulating general practice is less developed and has run into difficulties because of errors in the use of data to assess the performance of practices. Critics of the CQC argue that this is symptomatic of the pressures it is under, notwithstanding a substantial increase in its budget and staffing.’

The report summary said: ‘This report concludes that the… reforms have resulted in top-down reorganisation of the NHS and this has been distracting and damaging.’

King’s Fund chief executive Chris Ham 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.’

Commenting on the report, BMA chair Dr Mark Porter said: ‘The Health and Social Care Act was opposed by patients, the public and NHS staff, but politicians pushed through the changes regardless. This report highlights the damage that has been done to the health service and the major shortcomings of the Act, which distracted attention from rising pressure on services and cost billions to introduce.

‘The test for any health policy should be whether it benefits patients, but a BMA survey of doctors found that 95 per cent did not believe the Act had improved the quality of services forpatients, with three quarters believing it has made the delivery of joined-up care more difficult1. This is because it prioritises competition over integration, a concern which is highlighted front and centre in this report.’



Readers' comments (7)

  • Vinci Ho

    (1) "I've never claimed to have a monopoly of wisdom, but one thing I've learned in this job is you should always try to do the right thing, not the easy thing. Let the day-to-day judgments come and go: be prepared to be judged by history." Who said that?
    (2) On HSCB:
    'The end of law is not to abolish or restrain, but to preserve and enlarge freedom'. John Locke
    Has HSCB done that? Not really as far as commissioners are concerned.
    (3)'We have now sunk to a depth at which the restatement of the obvious is the first duty of intelligent me.' George Orwell
    Unfortunately , we had a bunch of idiots rather than intelligent men.

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  • Vinci Ho

    In countries where honour and code still matter in politics , those politicians would have to come out in public , bow and resign .

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  • The whole thing was designed to facilitate the sale of the NHS to the corporate sector whilst blaming GPs for the outcome. At practice level, GPs were kept so busy running around to meet the requirements of the CQC and revalidation, that they were powerless to resist this attack on their profession.

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  • Historians and 31,000 current English GPs.

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  • As a gp for a deprived inner city practice, the changes have been an absolute disaster. The current government stated "no top down reorganisation of the NHS" but the exact opposite has happened. The impact has been felt far and wide in the NHS in all areas from primary to secondary care and community services. Social care has also not been spared. As a GP (and I'm sure practically all barring a few money focused politically driven GP " entrepreneural leaders") had no interest in taking on this responsibility. It has taken most GPs away from the core role of dealing with patients. It has had a devastating effect on morale, workload and bureaucracy. I now spend more time at meetings than as a clinician. It has driven many gps into early retirement, emigration or simply quitting the profession and continues to have a snowball effect in this direction. The rules of the HSCA has resulted in competition which is not in the interest of a socialist body like the NHS. It has result in cherry picking of selective services by the private sector and destabilisation of longstanding primary and secondary service viability. It is no surprise many hospital trusts are in deficit. It has also resulted in more quangos. The only benefactors have been senior management who having been made redundant with large payoffs and have since been reemployed in similar positions by other organisations. Other benefactors have been private organisations who have won contracts for background essential business services in the NHS or services such as NHS 111 and the resultant loss of the knowledge and experience of the decommissioned previous service has resulted poor services and organisation which is irreversible. And five years down the line, it looks like mergers and consolidation and lack of gp interest is resulting a return to structures similar to the old SHAs and PCTs! I finding it incredible that all the political parties are cherry picking parts of the kings fund report to their advantage in this election year. They are all culpable in the destruction of the NHS. New labour started it, the lib dems endorsed it and the Tories...... Well I'm not sure what part of disastrous Jeremy hunt does not understand. It is interesting to see information relating to conflicts of interest of many politicians who voted on the HSCA. There should be accountability for the failure of these reform. There should be an independent public enquiry. Politicians should be stripped of any responsibility of decision making for the NHS other than providing the funding. An the ignorant public should a better understanding of what is happening.

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  • The 'scathing report' fell short of implicating the government for it's bid to privatize the NHS through the backdoor. I think, this is a serious setback as it fails to highlight a major factor for the mayhem that has ensued and leaves doors open for continuation of this hideous process.

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  • It doesn't really matter does it? The sheep will still vote Tory or Labour etc as they did before, Lansley will collect a peerage, nobody will be held to account for spending £3billion of taxpayers' precious money on pointless, un-needed and chaotic rearrangement of the desks.......
    If Labour wins they have promised another top-down unwanted upheaval.

    They never learn because they just don't care, they are playing tribal politics, they get to enact their ideological fantasies on the NHS, they never have to answer for their waste of eye-watering amounts of someone else's money.

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