The government's ambitious plans to reorganise the NHS will cost between £2bn and £3bn and distract from its core business of providing high quality care to patients, according to a highly critical editorial published online by the British Medical Journal. "For someone who has spent more than six years mastering the health brief in opposition, Andrew Lansley [the health secretary] seems to have learnt little from the history of NHS reorganisation," writes Kieran Walshe, professor of health policy and management at Manchester Business School.
The reality seems very different from Lansley's promise
"Closing down or merging organisations produces a round of expensive redundancies, early retirements and redeployment, while new organisations find new premises and appoint lots of new staff," he writes. Based on the NAO data, Walshe estimates that the cost of Lansley's NHS reforms will be £2bn-£3bn at a time of unprecedented financial austerity. "Reorganisations are often presented as an exercise in cutting bureaucracy, and this one is no exception, with the astounding claim being made that NHS management costs will be reduced by 45%," he writes. "It remains to be seen whether these changes, which involve abolishing 162 organisations and creating 500-600 new ones, will produce higher or lower management costs, but throughout the past two decades the numbers of NHS managers and the management costs of the NHS have grown steadily, regardless of reorganisation."
Most importantly, says Walshe, reorganisation affects the quality of service provision. It is a huge distraction from the task of providing good healthcare. It saps morale, creates uncertainty and can destabilise services, sometimes resulting in poor performance and failure. The plans need scrutiny inside and outside parliament, he says. "The government needs to produce empirical evidence – not ideological platitudes – to support the case for change." If the changes go ahead, the government should spell out the costs and benefits in a statement to parliament so that they can be properly measured in implementation, writes Walshe. He says a systematic analysis should be published within two years.
The Department of Health said in a statement that the reforms would put patients first and make health outcomes the best in the world. "We do not recognise the £3bn figure cited in this report," said a spokesman. "The reforms proposed in the white paper will cut the cost of bureaucracy, saving money that can be used to improve the quality and efficiency of the NHS. The costs associated with and the savings generated by our reforms will be published later this year, but the reductions in management costs we have already announced will save £850 million each year from 2013-14 alone."
In another critical article, the Lancet journal says it has been passed a document from the Oxfordshire and Buckinghamshire mental health NHS foundation trust outlining cuts to frontline jobs, including the loss of three psychiatrists out of 19 and 16 fewer care co-ordinators and support workers. The cuts are intended to save £5.3m over four years. The authors of the document admit the cuts will adversely affect services, says the Lancet. It talks of "possible reduction in the quality of service with less clinical resource available" at a time when demand for mental health services is growing. The editorial says the Oxfordshire experience may be common.
"This is an issue that challenges a fundamental commitment by the Liberal-Conservative coalition," it says. "And this is why we ask: Mr Lansley will you tell us the truth about NHS cuts? Because the reality seems very different from your promise."
the Guardian
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