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NHS shake-up will be repeated warn editors

Jo Carlowe

Tuesday, 31 January 2012

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The NHS will need another overhaul in five years time.

This is the stark message given today by editors of three leading healthcare publications. In an editorial published simultaneously by the BMJ, Health Service Journal and Nursing Times, the editors call for a public debate on the future of the NHS to ‘salvage some good’ from the government’s ‘damaging’ reforms.

While a second BMJ editorial says that abandoning the Health and Social Care Bill now would save just over £1 billion in 2013.

In the simultaneously published editorial, the editors say the NHS “is far too important to be left at the mercy of ideological and incompetent intervention” and argue “we must make sure that nothing like this ever happens again”.

As part of this process, they suggest parliament should now establish an independently appointed standing commission “to initiate a mature and informed national discussion on the future of our national health system”.

Although health professional groups differ in their stance on the bill, “there can be no doubting the overwhelming sense of distress and lack of confidence in the government’s plans among those who must deliver the service,” they write.

BMJ Editor Fiona Godlee, HSJ editor Alastair McLellan and Nursing Times editor Jenni Middleton argue that “through a combination of poor political judgement and reluctance to engage with criticism, a set of (mostly) reasonable objectives morphed into an old fashioned top down reorganisation. It also resulted in a bloated and opaque piece of legislation, whose goals could have largely been achieved by other, more effective, means”.

Once the bill becomes law, they believe that “we will still be in the dark about how much of the new system will work” and “we will have an unstable system that is only partially fit for purpose”. They also warn that “another major NHS reform programme is guaranteed within five years”.

It is possible, the three health editors say, to feel sorry for Lansley when – after years of being told that politicians should get out of the NHS – his proposals to loosen the health secretary’s grip on the service were thrown back in his face. But, they argue “those proposals were poorly thought through, and the government amendment restoring his responsibility for the NHS has failed to reassure some critics.”

So what lessons can we learn from this debacle, they ask?

Rather than relying on policy makers to build brave new worlds in back rooms, “we need a broad public debate on the principles that should underpin the NHS, how decisions on priorities should be made in a cash-limited system, and what role clinicians and private sector organisations could and should play”. This debate will require restraint on behalf of all involved, they add, if it is to escape being characterised yet again by polarised views, (often disguised) vested interest, political point scoring and conspiracy theories to the benefit of none.

The editors conclude: “Let us try to salvage some good from this damaging upheaval and resolve never to repeat it”.

In a second BMJ editorial published today, Kieran Walshe, Professor of Health Policy and Management at Manchester Business School says that abandoning the Health and Social Care Bill now would save just over £1 billion in 2013.

Dropping the bill now would also put an end to the prolonged and damaging period of organisational uncertainty in the NHS and would allow NHS organisations to focus on improving efficiency and productivity, and sustaining performance in the face of years of financial austerity, he argues.

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