I’ve kept pretty quiet about the NHS since I wrote this in January. I’m still convinced that the government’s proposed reorganisation will not only kill all hope of making significant efficiency savings but will also lead to a more expensive service, at least in the short-term.
So is the government’s decision to hang fire on the reforms for a few months a good thing? Well it might have been if they had done it sooner but, as Paul Corrigan notes, even though the NHS bill has not yet been passed, the restructure has already started. Across the country, PCTs have been merged and staff have been sacked.
At the end of last year, a London PCT Chief Executive warned that the NHS was throwing itself into the re-organisation at the expense of the £20bn efficiency savings demanded by the government.
This is to be expected. Given the choice between making productivity improvements and restructuring their organisations, most managers will choose the latter. Re-organisations are high-profile and make instantly visible changes. Productivity improvement, by contrast, is slow and incremental. The results are not always immediately apparent. If you want to look busy and in charge, there’s nothing like a good re-organisation. The NHS is no different and so, while little progress has been made on efficiency, the restructure is storming ahead.
Which is why the pause probably won’t do much good. The damage has already been done. Even if the government did try to put everything back together again and re-hire the people it has just sacked, it could not undo the disruption and loss of morale.
It’s possible that the delay might actually make things worse. This sort of uncertainty drains the energy from an organisation. NHS managers who thought they were preparing for one scenario are now left wondering whether they too should pause and see what happens or just carry on regardless. Some will push on, some will hold off and many will just dither. There will be more poring over organisation charts, more unfocused meetings and more water-cooler conversations. That’s what always happens in these situations, even in the best-run organisations.
Even if the government does a complete u-turn and scraps the whole idea, which is very unlikely, Andrew Lansley’s plan will already have cost the NHS dear. There is a contradiction between this re-organisation and the efficiency savings the government says it wants. Drawing out the uncertainty will just make matters worse.