BMJ 2015;350:h633 doi: 10.1136/bmj.h633 (Published 5 February 2015)
Page 1 of 1
News
NEWS Coalition’s changes to NHS were damaging and distracting, says new review Zosia Kmietowicz The BMJ
The reorganisation of the NHS in England under the coalition government was badly timed and has led to damaging and distracting effects, an assessment by the health policy think tank the King’s Fund has concluded.
The Health and Social Care Act, which was signed into law in March 2012 and took effect in April 2013, led to complex changes in the structure of the NHS at a time when the focus should have been on tackling an unprecedented funding squeeze and the growing demand for services, said the report.1 In a warning to political parties ahead of the general election in May, Chris Ham, chief executive of the King’s Fund and an author of the report, said, “Politicians should be wary of ever again embarking on such a sweeping and complicated reorganisation of the NHS.”
Getting the act into law took up the first half of the coalition’s parliament. During this time the health secretary for England, Andrew Lansley, ignored warnings from several quarters over his proposed changes and was determined to bring in legislation “so that a future health secretary could not modify or dilute” them, the report said. It was only the arrival of a new health secretary,2 Jeremy Hunt, in September 2012 that brought an important change in the government’s approach to the NHS, said the report, with a move away from the technocratic changes contained in the act to a focus on safety and the quality of care.
The report highlights some positive changes brought about by the act, including closer involvement of GPs in commissioning services, giving local authorities responsibility for public health, and establishing health and wellbeing boards. But it also describes ways in which the act has damaged the NHS. Despite promises before 2010 to allow local health bodies to make decisions about how their services should develop to meet the needs of the local community, since the act was implemented there have been regular ministerial interventions and a continued focus on targets, it said. The act has also led to an unwieldy structure, with leadership fractured among several bodies, a complex regulatory system, and a strategic vacuum in place of the leadership that was provided by strategic health authorities.
For personal use only: See rights and reprints http://www.bmj.com/permissions
And in terms of the act’s main aim—to expand competition—the result has been a more complex process and uncertainty among service commissioners about when contracts should be put out to tender.
The act also broke up commissioning, which used to reside with primary care trusts but is now split between clinical commissioning groups (CCGs), NHS England, and local authorities. The commissioning process has not been helped by the fact that NHS England was slow to establish itself because of its wide ranging responsibilities, said the report. It concluded, “Although it is too early to identify any real benefits of the new arrangements for commissioning, there is some optimism in the way in which CCGs are beginning to work more closely with local authorities through health and wellbeing boards.”
The report was more optimistic about the integration of health and social care and the move towards a fairer system for funding social care, largely because of the Care Act 2014. It also said that lately ministers have focused more on regulation and improving the standards of care. The next government should build on this by putting less emphasis on inspection and instead providing more support to staff to improve the care of patients and accelerating moves to achieve closer integration of services. Ham concluded, “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.” 1 2
Ham C, Baird B, Gregory S, Jabbal J, Alderwick H. The NHS under a coalition government—part one: NHS reform. 6 Feb 2015. www.kingsfund.org.uk. Hawkes N. Jeremy Hunt succeeds Andrew Lansley as health secretary. BMJ 2012;345:e5961.
Cite this as: BMJ 2015;350:h633 © BMJ Publishing Group Ltd 2015
Subscribe: http://www.bmj.com/subscribe
Page 1 of 1
News
NEWS Coalition’s changes to NHS were damaging and distracting, says new review Zosia Kmietowicz The BMJ
The reorganisation of the NHS in England under the coalition government was badly timed and has led to damaging and distracting effects, an assessment by the health policy think tank the King’s Fund has concluded.
The Health and Social Care Act, which was signed into law in March 2012 and took effect in April 2013, led to complex changes in the structure of the NHS at a time when the focus should have been on tackling an unprecedented funding squeeze and the growing demand for services, said the report.1 In a warning to political parties ahead of the general election in May, Chris Ham, chief executive of the King’s Fund and an author of the report, said, “Politicians should be wary of ever again embarking on such a sweeping and complicated reorganisation of the NHS.”
Getting the act into law took up the first half of the coalition’s parliament. During this time the health secretary for England, Andrew Lansley, ignored warnings from several quarters over his proposed changes and was determined to bring in legislation “so that a future health secretary could not modify or dilute” them, the report said. It was only the arrival of a new health secretary,2 Jeremy Hunt, in September 2012 that brought an important change in the government’s approach to the NHS, said the report, with a move away from the technocratic changes contained in the act to a focus on safety and the quality of care.
The report highlights some positive changes brought about by the act, including closer involvement of GPs in commissioning services, giving local authorities responsibility for public health, and establishing health and wellbeing boards. But it also describes ways in which the act has damaged the NHS. Despite promises before 2010 to allow local health bodies to make decisions about how their services should develop to meet the needs of the local community, since the act was implemented there have been regular ministerial interventions and a continued focus on targets, it said. The act has also led to an unwieldy structure, with leadership fractured among several bodies, a complex regulatory system, and a strategic vacuum in place of the leadership that was provided by strategic health authorities.
For personal use only: See rights and reprints http://www.bmj.com/permissions
And in terms of the act’s main aim—to expand competition—the result has been a more complex process and uncertainty among service commissioners about when contracts should be put out to tender.
The act also broke up commissioning, which used to reside with primary care trusts but is now split between clinical commissioning groups (CCGs), NHS England, and local authorities. The commissioning process has not been helped by the fact that NHS England was slow to establish itself because of its wide ranging responsibilities, said the report. It concluded, “Although it is too early to identify any real benefits of the new arrangements for commissioning, there is some optimism in the way in which CCGs are beginning to work more closely with local authorities through health and wellbeing boards.”
The report was more optimistic about the integration of health and social care and the move towards a fairer system for funding social care, largely because of the Care Act 2014. It also said that lately ministers have focused more on regulation and improving the standards of care. The next government should build on this by putting less emphasis on inspection and instead providing more support to staff to improve the care of patients and accelerating moves to achieve closer integration of services. Ham concluded, “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.” 1 2
Ham C, Baird B, Gregory S, Jabbal J, Alderwick H. The NHS under a coalition government—part one: NHS reform. 6 Feb 2015. www.kingsfund.org.uk. Hawkes N. Jeremy Hunt succeeds Andrew Lansley as health secretary. BMJ 2012;345:e5961.
Cite this as: BMJ 2015;350:h633 © BMJ Publishing Group Ltd 2015
Subscribe: http://www.bmj.com/subscribe
