Editors of the British Medical Journal, Tony Delamothe and Fiona Godlee, have written a scathing assessment of Andrew Lansley’s proposals for the NHS. They are writing from a doctor’s perspective rather than a manager’s yet they draw almost identical conclusions to the ones I came up with earlier this month. Here’s their opening shot:
What do you call a government that embarks on the biggest upheaval of the NHS in its 63 year history, at breakneck speed, while simultaneously trying to make unprecedented financial savings? The politically correct answer has got to be: mad.
As they say, you only have to look at the history to see that Mr Lansley’s timetable is straight out of la la land:
The bill promises that all general practices will be part of consortiums by April 2012, yet it took six years for 56% of general practices to become fundholders after the introduction of the internal market. Nearly seven years after the first NHS trust was granted foundation status, there are still more than half to go—within two years.
Even those who are broadly in favour of introducing greater competition between suppliers, such James Gubb of Civitas and Bristol University’s Carol Propper, are sceptical about the government’s proposals and timing.
In a balanced piece, which started off by dismissing some of the wilder claims of the government’s opponents, Professor Propper suggested that Andrew Lansley’s plan might fail, even under its own terms:
[I]t is not clear that replacing PCTs with GP consortia at this stage in the reform process will help develop the gains that competition between suppliers has been shown to have had and creating a new set of purchasers will undoubtedly take a lot of attention, resources and time. In my view these resources would have been better used in developing choice to a greater degree, getting the rules of the game right and then introducing, at a later date, a large role for those GPS that want it.
The weight of evidence and expert opinion is so heavily against the government’s proposals that it is difficult to find anyone outside the Coalition laager who believes that they are achievable in the timescales or even that they will deliver a better health service once they are finally implemented.
This weekend, another right-of-centre think-tank, the Centre for Social Justice, accused the government of making spending cuts without any clear objectives, evidence or measures of productivity. The proposed NHS reforms are the clearest case of policy made on the basis of hunches.
“Know what? I reckon we should re-organise the health service, sack a load of time-servers and put the local doctors in charge.”
“You sure that’s gonna work?”
Hey, c’mon Chief, I gotta hunch about this one. Back me up on it will ya?
The Health Secretary says that people “woefully overestimate the scale of the change”. It’s beginning to look like it’s the other way around – that Mr Lansley has woefully underestimated the cost and timing of the change. Ranged against the government’s hunch is just about everyone who has taken more than a cursory glance at the evidence.
Presumably, as eminent medics and editors of a respected journal, Tony Delamothe and Fiona Godlee are not given to hysterical over-statement. There really is no other way to describe the government’s NHS proposals. They are, indeed, mad!