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‘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.’