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New report on the NHS: the post-Francis case for reform

Elliot Bidgood, 4 July 2013

Tomorrow is the 65th anniversary of the founding of the National Health Service. However, while a respected part of British national life and rightly lauded for its core principles, this year the service has faced considerable tumult; the fallout of Mid Staffordshire and the Francis report, investigations into high mortality at 14 other trusts, Morecambe Bay, the uncertainty created by the April commissioning reorganisation and the on-going trend of ever-increasing demands and tightening funding. It is against this backdrop that my new report, After Francis: Standards & Care Quality in the NHS, looks at how the NHS and its approach to patient care is faring and whether the Francis report recommendations and various other proposals on the current health reform agenda will be sufficient to tackle current challenges.

78614322Key points:

  • As Robert Francis QC said, parts of the system seemed “focused on doing the system’s business – not that of the patients” – a fundamental examination of many parts of the NHS is needed
  • On top of the care and mortality issues highlighted in Mid Staffordshire and elsewhere, the UK also lags comparable nations on avoidable mortality. Relatively high satisfaction is still reported with the NHS, but this may come down to reportedly good performance by the NHS on service elements more visible to the public (accessibility, patient engagement, out-of-hours care) – systemic clinical outcomes and mortality rates, by contrast, are less easily perceptible and need to be tackled
  • Managerial accountability and inspections should be strengthened, but similar pledges were made after previous scandals and it has already been reported that three-quarters of hospital chief executives are sceptical about reforms to the NHS inspectorate
  • Growing recognition of the distortions caused by central targets in Mid Staffordshire and elsewhere is encouraging, but in the absence of firm targets, new outcome frameworks will need to be paired with strengthened information availability and patient choice
  • There is, in the words of an LSE professor and former Blair-era Health Department economist, a “growing evidence base” from many respected sources demonstrating the positive effects competition and patient choice are already having in the NHS. Civitas has also found this year that the public are broadly comfortable with the idea of diversity of provision on the NHS
  • Integration of NHS and social care services is needed and the commitment of all three political parties to this goal is encouraging. However, we need a nuanced and evidence-based debate about the relationship between competition and integration – neither should be allowed to undermine the other

Finally, Mid Staffordshire and broader performance issues may demonstrate something about the drawbacks and inherent lack of clear accountability in our current health system model. It is time that we seriously examine Scandinavian-style decentralisation of health services and continental-style universal Social Health Insurance as ways in which we can continue to uphold the NHS’s essential and cherished aim of providing universal and equitable access to care, but within a system that is proven to give consumers in the health system more control and drive up standards.

For more of our work on health, including books and research papers, visit our website here.

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