Not that ‘unprecedented’

James Gubb, 5 July 2007

Alan Johnson yesterday launched an ‘unprecedented’ review of the NHS, to advise on how to meet the challenges of delivering health care over the next decade. In particular this will examine how the NHS can provide better access to safer, high quality care for all, whilst delivering value for money for taxpayers. Sounds great, but while this may be unprecedented for Mr Johnson in his week-long tenure as Secretary of State for Health, it is hardly unprecedented in the recent history of the NHS – there have been two in the last five years, both of which have been very general in their nature.

I guess what is new about it is that this one will be led by Prof Ara Darzi, the newly appointed junior health minister, who has in the words of the HSJ’s editor, Richard Vize, still got ‘one foot in the theatre’. His appointment is a positive – the government have clearly failed to take the medical profession with them in the mass of often contradictory reforms that the NHS has endured in the past decade. Yet, from a cynic’s point of view, this review looks like something of a cop-out designed to appease the BMA, the medics and the public, who in the oh-so-sympathetic words of Alan Johnson are ‘not happy bunnies’ despite the money that’s been ploughed in. The Department of Health promise that the review will not bar change in the interim, but it smacks of an attempt to dissolve responsibility for what has happened, and is happening in the NHS, from people’s minds. It’s ok, we’re in the middle of a review, we’re asking you what you want, it’ll all be fine. But will it?
Andrew Haldenby, director of Reform, is quoted in the Times saying: ‘This is exactly the wrong moment to kick health policy into the long grass. The evidence is mounting that the DH’s reform drive has lost momentum just as the service’s big funding increases come to an end’. Too true. Indicative of this is Alan Johnson’s decision to downplay the role of the private sector, stating that he will only sign contracts for ISTCs if they were needed to fill gaps in NHS capacity, rather than to spur competition – the second wave of ISTCs looks certain, in the main, to collapse. A report commissioned by the NHS commercial directorate estimates that the NHS needs to buy 450,000 to 500,000 procedures a year from ISTCs if the market is not to collapse. Yet currently only 170,000 are being carried out.
Mr Johnson has promised the review will not challenge the commitment to allow patients to choose between NHS hospitals. But if he’s really committed to this idea, he must also accept that there should be a genuine market for healthcare in this country. If so, the NHS not only needs the input of ISTCs badly, but dithering around for another 11 months while this review is being prepared could prove disastrous, if a recent report by the King’s Fund is to be believed – and it should. Caught in no-man’s land between a market and central direction, the NHS will suffer the worst of both worlds – the extra costs of competition without any of the benefits.
It seems outside of the review’s remit to ponder more radical (and I would argue necessary) reforms, such as liberalising the demand side – general taxation looks set to continue. If so, then the fact of the matter is that everyone knows what needs to be done; the genie that is the market for healthcare has popped out of the bottle and none of the major political parties are seriously contemplating putting it back in. Patient choice is here to stay. Mr Johnson need look no further than his own speech for direction: ‘ensure that there is no further centrally dictated, top-down, restructuring to PCTs and SHAs for the forseeable future … [and that the] NHS is clinically-led, patient-centred and locally accountable…’. Remove the barriers to independent sector companies, incentivise local NHS staff and mangers to bring about real change, and free them all from central control.