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Is the NHS becoming more bureaucratic?

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Way back in 2009, when Andrew Lansley was a mere ‘health spokesperson’, he was pledging to reduce the bureaucracy in the NHS.

In a rabble-rousing speech to the Conservative Party conference, Mr Lansley said that by the end of its fourth year in power the Conservative government would have cut spending on bureaucracy by a third to £3bn a year.

At the time of the white paper, Mr Lansley was promising to cut management costs by 45% by removing PCTs and SHAs. But that was pre-listening exercise.

The ‘pause’ in the health bill to listen led to a myriad of ‘stakeholders’ and other vested interests entering the fray, and somehow this aim got lost.

What we ended up with was an almighty game of poker, with the Government desperately overplaying its hand to buy the support of its critics. Nurses underrepresented? Here is a full house of clinical senates. Problems with governance? I’ll ace you with local arms of a National Commissioning Board. Patient representation? Ha ha - citizen’s panel trumps royal flush. And so on.

This has led to a confusing new list of organisations with ill-defined responsibilities and the aim of the health bill to reduce bureaucracy looks like a busted flush.

Last week, the Labour Party gleefully handed round a rather helpful organogram (sounds rude, but isn’t) of ‘David Cameron’s New NHS Bureaucracy’ compared with the ‘Previous NHS Structure’. See the images here.

On first glance it looks pretty damning. There are lines and boxes everywhere with the poor old GP practices shoved right at the bottom. The Financial Times swallowed it hole, saying ‘Organograms show NHS becoming even more complex’ and it was enthusiastically retweeted after RCGP chair Dr Clare Gerada recommended it.

Now far be from me to go against the chair of the RCGP, but I am not convinced it is any more complex than it was before. The CQC, PBC clusters and GP practices are completely absent from the Labour era diagram (what does that tell you) and it conveniently includes PCTs, SHAs and their clusters that will not exist after the reorganisation. Smells like party politicking to me.

Labour have a vested interest in making it seem like the Government’s reforms are going to make the NHS more bureaucratic, but don’t forget they were the ones who introduced the whole ridiculous management structure, and don’t get me started on the money that was wasted on ‘Next Stage Reviews’, referral gateways and patient surveys.

Here is a message to all the politicians out there – butt out, you have done enough damage. We need to get back to what GP-led commissioning meant in the first place – locally accountable, responsive and not one-size-fits all. Then we might all stand a chance of actually putting the money saved back into treating patients.

Nigel Praities is deputy editor of Pulse

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