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”.
“NHS leaders at all levels were distracted as they were required to rearrange the deckchairs rather than navigate safely past the iceberg,” the report said.
“NHS leaders at all levels were distracted as they were required to rearrange the deckchairs rather than navigate safely past the iceberg”
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 criticised the reforms introduced by former health secretary Andrew Lansley.
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 said the section 75 rules on competition created uncertainty about whether contracts should be put out to tender.
It added that there was “no evidence” that competition had brought about “sufficient benefits” to outweigh its “transaction costs”, though more time was needed to confirm this.
The report said 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”.
It said 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”.
The report added that it was a “moot point” whether the renewed faith in regulation under Mr Lansley’s replacement Jeremy Hunt was well placed.
It recommended that whoever forms the next government should move the emphasis away from inspection to supporting frontline teams.
Peter Carter, chief executive and general secretary of the Royal College of Nursing, said: “The unnecessary and distracting chaos that this report describes echoes our warnings and shows the importance of listening to the concerns of NHS staff.
“It is particularly galling for patients and staff that this reorganisation cost the NHS so much money at a time when financial pressures are squeezing patient care harder than ever before,” he added.