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Dr Lansley’s Monster
BMJ Editorial 21 January 2011
http://www.bmj.com/content/342/bmj.d408.full

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.

The scale of ambition should ring alarm bells. Sir David Nicholson, the NHS chief executive, has described the proposals as the biggest change management programme in the world?the only one so large “that you can actually see it from space.” (More ominously, he added that one of the lessons of change management is that “most big change management systems fail.”) Of the annual 4% efficiency savings expected of the NHS over the next four years, the Commons health select committee said, “The scale of this is without precedent in NHS history; and there is no known example of
such a feat being achieved by any other healthcare system in the world.”

To pull off either of these challenges would therefore be breathtaking; to believe that you could manage both of them at once is deluded…

Informed opinion about GP commissioning, past and present, has been almost universally negative. The previous government’s primary care tsar branded
practice based commissioning “a corpse not for resuscitation.”….

The health secretary has made much of these changes being evolutionary rather than revolutionary. People “woefully overestimate the scale of the change,” he said. After all, practice based commissioning, choice of provider, an NHS price list, and foundation trusts already exist. True, but a week later came the revelation that hospitals would be allowed to undercut the NHS tariff to increase their business. Health economists queued up to say what a terrible idea this was, citing evidence that it would lead to a race to the bottom on price, which would threaten quality. Taken with the opening up of NHS contracts to European competition law, it was the last piece of evidence needed to convince critics that the government was unleashing a storm of creative destruction onto the NHS, with the imperative: compete or die.

Whatever the eventual outcome, such radical reorganisations adversely affect service performance. As Kieran Walshe wrote, they are “a huge distraction from the real mission of the NHS to deliver and improve the quality of healthcare.”

Dave Gordon
Townsend Centre for International Poverty Research
University of Bristol