The coalition government’s flagship legislation on health was ‘damaging and distracting’, and ‘historians will not be kind in their assessment’ of its record on NHS reform, an influential think tank has claimed.

In a major report examining health reform under the coalition, the King’s Fund argues that the decision to reorganise the NHS with the Health and Social Care Act in 2012 distracted the service from the much more urgent tasks of responding to growth in demand and squeezed finances.

According to the authors, the “massive organisational change” resulting from the act contributed to the current “widespread financial distress and failure to hit key targets for patient care”.

Chris Ham

The next government must not ‘engage in top-down structural change of this kind’, Chris Ham said

“NHS leaders at all levels were distracted as they were required to rearrange the deckchairs rather than navigate safely past the iceberg,” the report says.

While it identifies some positives, such as the closer involvement of GPs in commissioning, the handing of public health to local authorities and the creation of health and wellbeing boards, the report strongly criticises the reforms.

The bill was supposed to be about streamlining the NHS, but it resulted in a “bewilderingly complex… Heath Robinson construct” where leadership was “fractured” between many bodies, creating a “strategic vacuum”.

The King’s Fund argues that commissioning was similarly “fragmented”, with NHS England only now repairing the damage by devolving more responsibility for primary care and specialised services to clinical commissioning groups.

While claims of “mass privatisation” because of the act “were and are exaggerated”, the report says the section 75 rules on competition created uncertainty about whether contracts should be put out to tender.

It adds there is “no evidence” that competition had brought about “sufficient benefits” to outweigh its “transaction costs”, though more time was needed to confirm this.

The report says the desire behind the reforms to reduce political micromanagement of the NHS has also not been realised, with the period since the act “characterised by regular ministerial intervention and a continued focus on targets”.

The report says the reforms were so counterproductive that much of the second half of the current Parliament has ended up being devoted to “limiting the damage caused by the bill”.

Speaking to HSJ, King’s Fund chief executive Chris Ham said there had been a welcome shift away from technocratic change to a focus on safety and care quality since Jeremy Hunt succeeded Andrew Lansley as health secretary in 2012.

The appointment of Norman Lamb as care minister at the same time also had the positive effect of pushing integration further up the agenda, he added.

Professor Ham said the key lesson for whoever forms the next government was “under no circumstances to engage in top-down structural change of this kind”, though he added this should not stop “evolutionary changes” to develop new models of care.

He said Labour’s policies suggested “quite considerable further organisational change” and the party had “unanswered questions” about how much upheaval they could cause. But he said it was too early to say whether it would constitute a top-down reorganisation.

The report says it is a “moot point” whether the renewed faith in regulation under Mr Hunt is well placed, and recommends that whoever forms the next government should move the emphasis away from inspection to supporting frontline teams.