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The coalition government has moved quickly in its first 100 days to set out its plans for the NHS in England. Although ministers have stressed that these plans build on Labour’s health reforms, in reality they are much more radical.
Tony Blair’s policies may have paved the way for choice and competition to play a bigger part in the NHS, and Ara Darzi laid the foundations for quality of care to be taken seriously, but neither sought to do so at the speed and the scale now proposed.
The new government’s plans are genuinely distinctive in their intention to give general practices almost all of the responsibility for commissioning as primary care trusts are phased out. To persuade general practitioners to take on this challenge, the government will have to negotiate a revised contract with the British Medical Association, and this will take time. The need to reassure the Treasury on how GPs will be held to account for the use of budgets may be a further brake on progress.
Previous reforms have relied on general managers to act as the shock troops of change, most notably in the internal market introduced by the Thatcher and Major governments in the 1990s. The coalition government’s distrust of managers and its commitment to significantly reduce management costs mean that this option is not available this time round. Ministers have placed enormous faith in the ability of entrepreneurial GPs to make change happen and it remains to be seen whether this is justified.
So while the health white paper has set out a clear direction of travel, it is far from a done deal. The history of NHS reform is littered with examples of bold government plans that have been amended and compromised by the politics of healthcare and the difficulty of implementation. Often, it has been the power of doctors, both nationally through the BMA and locally through their role in influencing change, that has limited the impact of policies in practice.
The next thousand days will determine the fate of the government’s plans and their effect on patient care. Ministers and their officials will need to exercise consummate skill to negotiate the political and policy minefields that lie ahead as the hard work of implementation and delivery now begin.
This blog also appears on the King’s Fund’s website www.kingsfund.org.uk
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Readers' comments (2)
Anonymous | 18-Aug-2010 1:39 pm
Just to remind you Prof Ham - consultation on the White paper closes in Mid-October and legislative time for the Health Bill is booked in November. The legislation will already be being drafted. Response on consultation won't matter a damn. Time isn't a luxury we're being given.
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Derek Mowbray | 20-Aug-2010 9:02 am
By far the biggest problem for the NHS is why does it exist? The ambiguity surrounding the health services clearly fails to generate the degrees of commitment and emotional engagement needed to ensure that everyone who works in it concentrates on their work and not on other things, like new structures, bullying and other symptoms of presenteeism. It doesn't really matter is its GPs or Jo Bloggs who does the commissioning; what matters is their deep commitment to purpose and their understanding of how to achieve it - if the purpose is ambiguous then achieving it will fail. Therefore it doesn't matter if we respond to consultation or not as those in control of the NHS bask in its ambiguity to enable riggle room when things don't work out quite the way some people imagine. What is happening will merely ensure the NHS slips further down the effective health services chain to a point when insurance companies will step in and identify clear purposes for health care and organise their own delivery of services. I wish they'd step in now and do something to support initiatives relating to psychological wellbeing, performance and productivity - as this is so crucial to the economy as a whole, yet hardly pings on the radar.
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