Do the justifications for NHS reform stand up to scrutiny?

Lansley’s problem hasn’t only been a failure of communication. It has been a failure of justification and a lack of evidence.

Right after the white paper was announced I wrote, ‘extraordinary changes require extraordinary justification backed up by extraordinary evidence’
The Health White Paper, Equity and Excellence, was remarkable for its lack of references and so several months after it came out, the government produced some post-hoc justification in the form of a piece of PR on the No. 10 website: PM article on the Health and Social Care Bill. It was swiftly decimated by (most famously) Professor John Appleby (chief economist at the King’s Fund) and Ben Goldacre (Badscience blogger and columnist). The comprehensive deconstruction has been compiled by Richardblogger.
After the White Paper came the Health and Social Care bill. Again the government failed to add references or justification. So this time they ‘paused’ and produced another piece of PR called Working together for a Stronger NHS.
Ben Goldacre’s response was to say what most of us were thinking, ‘I’d expect this from UKIP or the Daily Mail, not a government leaflet’.

Update 23.2.2012. Last week the government produced another PR document in the form of 19 fact sheets. Another blogger, Chris Mason has made the forceful point that none of them are linked to any evidence!

Chris has also had an email exchange with the department of health in search of evidence about cancer deaths and the costs of new medicines. They were unable to provide references.

Moving on from fanciful claims about healthcare outcomes.

Will the health bill streamline NHS management?

Here are 2 interesting links for the benefit of readers who do not follow twitter.

The first is an organogram of NHS structures from the Financial Times last year showing the difference before and after the bill.

The second is a blog from Paul Corrigan  (previously health policy advisor to Tony Blair 2005-7) published today, in which a GP explains to his constituency MP where responsibility for local health services will lie after the bill.

The answer to the question, “will the Health Bill streamline NHS management?”, is an emphatic, “no”

Not one of the other justifications for NHS reform including: putting doctors in charge, empowering patients, improving health outcomes, the ageing population and containing costs, stand up to scrutiny.

The press, with very few exceptions, have accepted the justifications without bothering to investigate them. If Lansley says we need to reform the NHS because of an ageing population is it so self-evidently true that they don’t check it out, or is there another reason? (Ageing adds about 0.5%-1% to healthcare costs per year)

If Lansley says that GPs are the best people to take on NHS commissioning, do they ask, “I wonder what that involves? Are they trained to do that? Is it like treating patients or running a surgery?” (It’s a mixture of legal-contracts, public-health needs assessment and complex administration, nothing like runnning a surgery) Do they wonder about the 40% of NHS services including local services like health-visitors and primary care that will be commissioned centrally? Or do they question the intention that “The NHS sector, which provides the majority of commissioning support now, needs to make the transition from statutory function to freestanding enterprise” (i.e. it will be privatised and run by international insurance companies, not your friendly local GP)?

The medical profession, being a mixed bunch, have fallen into a small, but politically ambitious camp of reform enthusiasts, and a far larger group of evidence-based practitioners who have seen the justifications as the snake-oil pedalling it is.

See also:

Why the NHS reforms won’t do what they say on the tin. Bevan’s Run

What is the problem the NHS bill is supposed to solve? Ian Greener

How the NHS measures up to other health systems. Open access link BMJ 22.02.2012 Guardian.

Measuring NHS performance using amenable mortality. Interpret with Care JRSM

The consequences of abandoning the Health and Social Care Bill. BMJ

Changes to the NHS have created an ‘unholy mess’ BBC

Cameron’s NHS Myths

Is the NHS Commissioning Board really being set up to liberate CCGs? NHS Alliance

“The UK is one of the best performers in the world. But outcomes are not what you expect because there is a big reform every five years. We calculate that each reform costs two years of improvements in quality. No country reforms its health service as frequently as the UK,” said Mark Pearson, head of health at the OECD.
When it was put to Pearson, a respected economist, that the NHS faces its biggest upheaval in 60 years with the coalition’s health bill, he said: “The NHS is so central to the political process that every politician has to promise to improve the NHS. But there’s no big reform that will improve it. Better to let it bed down and tinker rather than wondering about more or less competition. It is less the type of system that counts, but rather how it is managed.”
Full story at:

3 responses to “Do the justifications for NHS reform stand up to scrutiny?

  1. Thanks for this. Very helpful summary.

  2. I thought the report on the BBC was ambivalent. They suggested that doctors were not really behind this comment ‘creating a unholy mess’ and they found one doctor who spoke in favour of it. There also seems to be very little reporting of what is happening re the NHS and a general attitude of sitting on the fence. No reporting of the sort of reactions we read on here.

  3. Pingback: What are the NHS reforms for? « Ian Greener's Academic Blog

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