The content of this website is intended for healthcare professionals only

Health reforms ‘damaging and distracting’, says The King’s Fund

Damage to NHS ‘profound and intense’, says lead doctor

Jo Carlowe

Friday, 06 February 2015

The Coalition’s health reforms have been ‘damaging and distracting’, according to a new report by The King’s Fund.

In a major assessment of the coalition government’s record on NHS reform, The King’s Fund concludes that the major upheaval caused by the Health and Social Care Act was distracting at a time when the NHS should have been concentrating on growing financial and service pressures. 

Although the new report highlights some positive developments including closer involvement of GPs in commissioning services, giving local authorities responsibility for public health and the establishment of health and wellbeing boards, it goes on to criticise the decision to implement complex organisational changes during an ‘unprecedented funding squeeze’. 

Other key findings from the assessment of the Act are that: 

  • an unwieldy structure has emerged with leadership fractured between several national bodies, a bewilderingly complex regulatory system and a strategic vacuum in place of the system leadership that was previously provided by strategic health authorities
  • while claims of widespread privatisation are exaggerated with less than 10% of the NHS budget spent on non-NHS providers, the emphasis on competition has resulted in greater complexity and uncertainty about when contracts should be put out to tender
  • despite the intention to devolve decision-making and reduce political interference, the period since the Act was implemented has been characterised by regular ministerial intervention and a continued focus on targets
  • responsibility for commissioning has been fragmented between different bodies and NHS England has been slow to establish itself, weighed down by its wide-ranging responsibilities
  • although not an explicit aim of the original reforms, progress has been made in developing integrated care and the Care Act 2014 is an important step towards a fairer system for funding social care

The report highlights a significant change in the coalition's approach to the NHS, with the second half of the parliament characterised by a welcome shift away from the technocratic changes contained in the Health and Social Care Act to concentrate on safety and quality of care. 

Ministers have turned their attention away from competition and choice to focus on regulation and transparent reporting of performance data to improve care standards. The report argues that the next government should build on this with less emphasis on inspection and more support for hard-pressed staff to improve patient care, and accelerate moves to achieve closer integration of services.

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 were wasted on major organisational changes when the NHS should have been concentrating on growing financial and service pressures – this was a strategic error. Only latterly has the government adopted a more positive focus on improving patient care and achieving closer integration of services. Politicians should be wary of ever again embarking on such a sweeping and complicated reorganisation of the NHS.”

Responding to the report, Dr Mark Porter, British Medical Association council chair, 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 test for any health policy should be whether it benefits patients, but a BMA survey of doctors found that 95% did not believe the Act had improved the quality of services for patients, with three quarters believing it has made the delivery of joined-up care more difficult. This is because it prioritises competition over integration, a concern which is highlighted front and centre in this report.

“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.”

Registered in England and Wales. Reg No. 2530185. c/o Wilmington plc, 5th Floor, 10 Whitechapel High Street, London E1 8QS. Reg No. 30158470