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Thomas Cawston of Reform Think Tank: NHS reform is a necessity but the Coalition chose the wrong reforms

David Cameron famously claimed his three priorities for Government could be summed in three letters: N-H-S. However, the Coalition could never have neutralised the NHS as a political issue. As today’s Health Select Committee report rightly points out, improving value for money without reducing the quality of care is one of key public policy challenges of this Parliament. Meeting this challenge demands reform. The report equivocally states that making the NHS more efficient means “making fundamental changes to the way care is delivered. As Stephen Dorrell stated this morning “changing not the way the system is managed, but the system itself”.
The key message of the report is that efficiency savings are not happening fast enough and being made in the wrong way. The report expressed concerns that savings are being made “through ‘salami-slicing’ existing processes instead of rethinking and redesigning services”. The report also suggested that short term thinking rather than long term planning would make it harder for the NHS to become sustainable. Many have already argued that the Government is falling behind. According to the Department of Health’s own figures the NHS fell short of its forecast savings for the first half of the year. The evidence on the ground is of NHS organisations falling behind, yet the Secretary of State remains in denial. Speaking on the Today programme Andrew Lansley claimed to be “on track” and denied claims that we efficiency savings were turning into cuts.
However, with the Health and Social Care Bill on the final leg of its difficult journey through Parliament, today’s report has been seen as another call that the Government should drop its reforms. Last week the Royal College of Nursing joined the list of those arguing that the Government must focus on efficiency and announced outright opposition to the Health Bill. Certainly, reorganising the management of the NHS has distracted NHS leaders. However, the cuts to services have been caused by the failure to reform the system. The Government’s reforms did not focus on value for money, or on creating the competition and diversity that are needed to drive improvement. Instead, under the guise of empowering local clinicians, the Government has rearranged the management in a system that is now more centralised than before.
While Tim Montgomerie is right to note that the Government has brought its NHS problems on itself, reforming the NHS was always going to be the challenge that the Coalition would need to grasp. The rises in health spending under the last Government was becoming unsustainable and delivering value for money was essential. Reform was necessity not a choice. The Government’s problems did not start through failing to communicate unnecessary reforms, but with choosing the wrong reforms.


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