The Conservatives say they will replace central targets and reforms with a focus on patient outcomes. Helen Mooney looks at their plans
Last week the Conservative Party went head-to-head with the government on one of the traditional political battlegrounds – the NHS.
With the health service about to celebrate its 60th birthday while facing yet more government reforms, the Conservatives chose this month to unveil their most concrete set of proposals on health for some time.
The opposition has pledged to scrap ‘top down’ process targets if they win the next election. They declared the ‘bureaucratic approach, running our health service through perpetual political interference and the imposition of top-down targets, is failing patients and undermining hard-working doctors and nurses’.
Launching their vision for the future of the NHS – a green paper entitled Delivering Some of the Best Health in Europe – they criticised the government for sticking to arbitrary targets, which they said often focused on predetermined processes with little clinical benefit.
‘This target-driven approach diverts precious time and money from genuine clinical priorities, and is driven by political imperatives rather than patients’ needs,’ the paper states.
The Conservatives want to assess the performance of the NHS by measuring outcomes. Tory leader David Cameron said his party would focus on ‘what really matters to people’ in a speech last week outlining the policies at the Royal College of Surgeons in London.
He said he wanted to free nurses and doctors from a ‘tick boxes’ approach, which would help them concentrate on long-term conditions and cancer survival. He added he wanted to measure how well patients were after treatment, instead of how long someone waited in A&E.
‘The professions can focus on the result itself, not how it is achieved,’ he said. ‘We’ve got a system where we pump the same money into our health system as other countries but the thing that actually matters – a patient’s health and the results of their actual treatment – we’re doing worse,’ he claimed.
‘Seriously, if the NHS isn’t about improving the health of people – making them live longer, happier and more fulfilling lives – then what is it about?’
The Conservative Party has set out a list of six NHS promises:
Five-year survival rates for cancer above EU averages by 2015;
Premature mortality from stroke and heart disease below EU averages by 2015;
Premature mortality from lung disease below EU averages by 2020;
Year-on-year improvement in outcomes reported by patients living with long-term conditions;
Year-on-year improvement in patient satisfaction with access to, and experiences of, healthcare;
Year-on-year reduction in the number of adverse events.
In the week before the government announced its latest shake-up – the NHS Next Stage Review – Mr Cameron was at pains to stress that the Conservatives did not intend to achieve their NHS ambitions
with more reorganisation.
‘I know what you’re thinking – great ambition but how are you going to deliver it?,’ he said. ‘One thing I’m sure of – we
won’t get there though yet another massive structural reorganisation.
‘The past decade has witnessed a series of restless changes which, to the NHS itself, have felt like a series of frontal assaults.
We’ll offer steady, purposeful change with a clear direction.’
The Conservative green paper also says that it will provide a new accountability mechanism for the NHS, which will lead to ‘higher-quality healthcare, higher patient satisfaction, and higher professional morale’.
‘We will harness the power of information, publishing details of healthcare outcomes so that the professionals can see what works and what doesn’t,’ the document states.
The proposals have received a markedly mixed response from NHS staff representatives, who have been largely pro government over recent years.
Louise Silverton, the Royal College of Midwives’ deputy general secretary, said the college was pleased the Conservatives were planning to reward performance based on outcomes.
‘We [also] applaud them for proposing a move towards a system that encourages quality care,’ she said.
RCN general secretary Peter Carter said he was pleased the Conservatives had acknowledged the college’s research into the damage the emergency care four-hour target had on the patient experience (NT News, 3 June, p5).
‘Nurses clearly believe that by reducing the target slightly – from 98% to 95% – patients in A&E departments would receive a better service,’ he said.
NHS Confederation policy director Nigel Edwards praised the green paper for containing a ‘number of very sensible policies to take the NHS forward’.
‘The NHS needs to fundamentally increase the amount of data it collects in order to create better services,’ he said.
‘We also need to give staff the means to make the most of this data, for example through an NHS investment bank or a knowledge portal, so that they can innovate and help lead service improvement.’
Unison, however, hit out at the Conservatives’ proposals. Karen Jennings, the union’s head of health, said: ‘The Tories are looking to cash in on the hard work and new investment that Labour has pumped into the NHS. Thanks to that and the efforts of staff, the NHS is [already] set to meet many of the targets outlined by Mr Cameron.’
The King’s Fund health think-tank also sounded a note of caution. ‘The Conservatives’ plan to abolish central targets needs to be considered carefully,’ said its chief executive Niall Dickson. ‘Before we drop central targets altogether, we must be sure that there are appropriate safeguards to ensure standards and aspirations are in place.
‘To be fair to the NHS, it has already recognised that it needs to move on from an exclusive focus on centrally imposed targets towards measuring health outcomes. For example, from next year it will become mandatory for the health service to collect outcome data on some routine surgery such as hip and knee replacements.’
For the first time in about a decade, the Conservatives may have a chance of turning their rhetoric into reality. If they are to achieve their NHS aims, Mr Cameron should perhaps recall some of his previous comments.
Speaking in January 2007 at a London conference on the future of nursing, he told nurses they were the ‘real gatekeepers of the NHS’. ‘If we get nursing right, we get the NHS right,’ he said.