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Thomas Cawston: Fewer hospitals, more competition

Thomas Cawston is a Reform researcher

Today the Government will present the Health and Social Care Bill before Parliament. The proposals for the reorganisation of commissioning in the NHS contained in this bill have been the subject of wide debate and controversy. However significant as this debate is, it is important to not lose sight of the need for real reform to how healthcare is delivered.

 In December, Reform held a health summit to address the key issue of the future for hospitals in the new health service. The summit demonstrated the cross-party support for reconfiguration of services and reducing the number of hospital beds. Speaking for the Department of Health, Earl Howe said, “moving away from hospitals and a reduced number of unplanned admissions, all that will mean that bed numbers will fall.” Dr Peter Carter of the Royal College of Nursing agreed: “in some hospitals at any given time, up to 40 per cent of people simply don’t need to be there … they need help, they need treatment, but they don’t need to be in hospital.” The Shadow Health Minister Liz Kendall MP recognised that “the increase in patients with complex and long term conditions means shifting services into the community to avoid hospitalisation and improve prevention.”

But as well as shifting care out of hospitals, hospital services themselves need to be transformed. With fewer hospitals, more competition is needed to drive up productivity and encourage innovation. As Earl Howe noted, “real, informed choice means that people will choose the best provider, money will follow and it will flow to the best providers.” The former Liberal Democrat Shadow Health Spokesperson, Norman Lamb MP also made the case for competition in healthcare: “it is not the old monopoly providers who are the ones who innovate, who find new ways of doing things, new service delivery design, it is almost always insurgent new arrivals in an industry that can redesign the way a service can be provided.”

 Andrew Lansley has set out reforms that aim to make the NHS accountable to patients and local authorities, not politicians in central government. However there is a question of whether these reforms will be sufficient to transform how healthcare is delivered to ensure higher quality and lower cost. Speaking at Reform’s summit Professor Steve Smith, Chief Executive of Imperial College Healthcare NHS Trust, argued that “we need to move much faster in the United Kingdom. All of the issues about shifting care, it is not about preventing people coming to hospital, it is about providing better care.” As Hannah Farrar, of NHS London also noted “we do have ways of dealing with failing organisations or over capacity in the system and yet we continually delay making the difficult decisions.”

The Government is under sustained attack from those who would oppose any NHS reform. The Reform summit presented evidence from within the NHS and across the political spectrum that in fact reform needs to go further and faster. In May last year the Government released new guidelines that have made it even harder to change hospital services. It should revisit these if it wants its ambitions for NHS reform and efficiency to succeed.


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