‘Billions wasted’ on ‘damaging’ NHS reforms, think tank claims

Photo: James Bass.

Photo: James Bass. - Credit: Evening News © 2009

Billions of pounds that could have been spent on patient care were squandered on 'damaging and distracting' health reforms, an influential think tank has claimed.

The coalition Government's controversial shake-up of the NHS was 'misguided', resulting in an 'unwieldy' organisation structure that is 'not fit for purpose', according to The King's Fund.

Former health secretary Andrew Lansley's radical reforms came under attack in a highly critical assessment of the Government's record on the health service.

However, the King's Fund said there had been a 'significant' change in approach in the second half of the parliament as Mr Lansley's successor Jeremy Hunt presided over 'damage limitation' and a 'welcome shift away from technocratic changes'.

The independent charity also said that claims of 'widespread privatisation' are exaggerated.

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Speaking ahead of the publication of the first of a two-part report titled The NHS under the coalition government, Chris Ham, chief executive of The King's Fund, said: 'Historians will not be kind in their assessment of the coalition government's record on NHS reform.

'The first three years of the coalition Government were wasted years because of the misguided focus on organisational changes that only recently has been compensated by this renewed emphasis on safety,quality and greater integration of care.

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'Billions of pounds will have been wasted on those misguided reforms.

'The NHS therefore at the end of the parliament is experiencing both financial pressures and challenges in hitting targets that matter to patients because time, effort and money that should have been spent on patient care has been diverted into complex organisational changes.'

The King's Fund did not pinpoint a figure for the cost of the changes rolled out in the Health and Social Care Act, which included measures such as giving GPs and other clinicians more responsibility for spending healthcare funds.

Ministers have estimated that the cost of implementing policies in the legislation at £1.5 billion, while Labour has claimed that the shake-up cost £3 billion.

Mr Ham said it was a 'strategic error' to concentrate on organisational changes when the NHS should have been focusing on growing financial and service pressures.

The report said that an unwieldy structure has emerged, with leadership 'fractured' between several national bodies, a 'bewilderingly complex' regulatory system and a 'strategic vacuum'. It also cited an increase in bureaucracy.

Mr Ham said he agreed with the view that the organisation of the NHS is 'not fit for purpose', adding: 'Nobody starting with a blank sheet of paper would end up creating anything like this.

'It was more fit for purpose before the reforms. It wasn't a perfect structure in 2010, but it was less imperfect than the one we have to work with now.'

He highlighted the issue of 'system leadership' at a local level.

'Nobody is in charge locally. There is not a body ... that has the oversight of how the NHS is run at a regional level or at an area level that can bring all these organisations together and try and get a common approach to dealing with financial and performance problems.

'I think from the Government's point of view that is a huge, huge risk.'

Asked about the impact on patients, he said: 'I think it means declining performance, particularly on waiting time targets.

'On safety and quality there has been a really strong refocusing.'

The King's Fund was less critical of the Government's approach to the NHS in the second half of the Parliament, saying ministers have turned their attention away from competition and choice to concentrate on regulation, improving patient care and achieving closer integration of services.

The report said: 'Since September 2012, Jeremy Hunt has taken the lead on damage limitation, studiously ignoring many of the reforms promoted by his predecessor and staking his claim as the defender of patients' interests in the wake of the Francis report into failures of care at Mid Staffordshire NHS Foundation Trust.'

Claims of widespread privatisation were played down in the report, which found that less than 10% of the healthcare budget was spent on non-NHS providers.

Mr Ham said: 'During the debate on the Bill ... we came out very clearly and said we don't support the legislation but you are crying wolf if you are arguing this is going to lead to the widespread privatisation of NHS care.'

Labour has previously pointed to claims of privatisation when attacking the Government on the NHS.

Labour seized on the report.

Shadow health secretary Andy Burnham said: 'Labour warned David Cameron that his reorganisation would damage the NHS and we now have independent authoritative evidence that that is what has happened.

'People will remember patients, nurses, doctors and midwives lining up in their thousands and pleading with the Government to call it off. But they ploughed on and plunged the NHS into the chaos we see today.

'The vast majority of NHS staff now say that David Cameron's reorganisation has harmed patient care.

'The sad truth is that by turning the NHS upside down and causing a crisis in A&E, David Cameron has made care problems more likely, not less.

'The Government should accept Labour's five-point plan to bring A&Es back up to acceptable standards.

'We will rescue the NHS with a £2.5 billion a year Time to Care fund - on top of Tory spending plans - to fund new staff, including 20,000 more nurses and 8,000 more GPs.'

Dr Mark Porter, of the British Medical Association, said: 'The Health and Social Care Act was opposed by patients, the public and NHS staff, but politicians pushed through the changes regardless.

'This report highlights the damage that has been done to the health service and the major shortcomings of the Act, which distracted attention from rising pressure on services and cost billions to introduce.

'The damage done to the NHS has been profound and intense, but what is needed now is an honest and frank debate over how we can put right what has gone wrong without the need for another unnecessary and costly top-down reorganisation.'

A spokesman for Mr Hunt said: 'We welcome the King's Fund's recognition that the Government's focus on patient safety and integrated care is right for the NHS' future.

'This independent assessment also puts paid to Ed Miliband's myth that the reforms were about privatisation and highlights why both the public and the health sector should be wary of Labour's plans for upheaval and reorganisation.'

Mr Lansley defended his tenure.

He said: 'The report is silent on the question of whether patient care has been improved, on which the evidence is clear.

'When I was health secretary, year-long waiting times were eliminated, hospital infections dropped to their lowest levels ever, and thousands of lives were saved, and continue to be saved from improved care.

'The NHS is now judged to be the best health service in the world. The number of administrators has fallen, doctors and nurses have risen, productivity has gone up, and waste has been cut by over £5 billion a year.

'Public sector reform has never been a popularity contest, but these reforms will last. The independence of NHS England from national politicians and the leadership of local GP will stand the test of time, and patients will continue to see the results.'

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