NHS reforms – who needs evidence when you’ve got a hunch?

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!

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6 Responses to NHS reforms – who needs evidence when you’ve got a hunch?

  1. Pingback: Tweets that mention NHS reforms – who needs evidence when you’ve got a hunch? | Flip Chart Fairy Tales -- Topsy.com

  2. Pingback: NHS reforms – who needs evidence when you’ve got a hunch? - Rick - Member Blogs - HR Blogs - HR Space from Personnel Today and Xpert HR

  3. An excellent summary of the Labour line in this argument. Continue to put the producer first, run the health service for it’s staff and pump more borrowed money in. Make sure it’s PFI to keep it off balance sheet so that the next generation can pay for it – after all they’re being born in the place. And if outcomes rise marginally we can claim it a great triumph. Simples.

  4. Penny says:

    I’m worried about the speed and scale of the change being proposed and the lack of evidence that it will work. Most of all I’m concerned about the lack of support – indeed the outright hostility – expressed about the plans by the people within the NHS who are going to have to make them work in practice. Making policy from within a laager doesn’t generally result in good policy.

  5. Mike says:

    There is an alternative reading of NHS reforms. They are intended to fail. The changes to dental chargers back in 1987(?) successfully wrecked NHS dentistry, forcing dentists and patients to go private.
    Is this too cynical? Not if you considere a government that wrecked the coal industry to prevent a challenge to its authority.

  6. Rick says:

    Polittiscribe – you can hardly call Civitas and the Centre for Social Justice Labour supporters. Carol Propper is an advocate of market reforms too – again not someone you would place in a left-wing camp.

    This is not a Labour line – most of the non-partisan people who look at these reforms objectively reckon they will be a disaster. Even the Commons health committee, led by a Tory MP, has condemned the plans, saying they will hinder rather than help efficiency savings:


    You don’t need to be left-wing to think this plan is risky and expensive, you just need to look at the evidence.

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