THE NHS costs £110bn a year in England alone, amounting to around 7 per cent of GDP. It employs more than 1.3m people, and its success or failure touches all of our lives, while indirectly affecting the strength of every business.
So it matters that, as reported yesterday, the government now sees its NHS policy as a “huge strategic error”. Apparently neither David Cameron nor George Osborne understood their party’s health policy at the beginning of this Parliament. One Downing Street adviser said that the Prime Minister did not “have a clue”. So it was no surprise that the government lost confidence in its own major NHS reforms in 2011, even before they were actually implemented.
The government is right to think again about its reforms, even if it had the right intentions. It wanted an NHS less subject to political interference and more answerable to patients. The reforms, unfortunately, did not deliver that. They blurred accountability by sharing power between central government, local government and GPs. With more than 25 organisations managing and regulating the NHS at the national level alone, the service has become trapped in a regulatory and bureaucratic maze.
More importantly, however, Cameron all but gave up on reform. His new argument is that “I am in politics not to take risks with the NHS, not to threaten the NHS, but to safeguard and improve the NHS.” Yet doing nothing is almost certainly the biggest risk he could take with the health service, given looming (and massive) pressures on its finances. Improving the NHS, including improving its productivity performance, will take disruption and change. A high quality and affordable NHS will need to do its business very differently. By giving up on the idea of change, Cameron lost his chance to build a public mandate for reform.
That reform has to include the workforce, which makes up the largest part of the NHS’s costs. Yesterday, a number of organisations representing NHS workers went on strike over pay freezes. Whatever the rights and wrongs of this particular dispute, ministers should support the idea of a smaller, better trained, more effective health workforce, just as they do for the police, civil service and local government.
All is not lost. There are superb examples of innovation and change in the NHS. This Parliament saw the first ever example of a failing NHS hospital put into administration. That act of management sanity was long overdue. Hospitals such as University Hospitals Birmingham and Salford Royal are using data to measure the performance of their doctors and drive necessary change. Various parts of the country are paying care providers according to the outcomes they achieve rather than their simple volume of activity. This is genuinely exciting and offers a bright new vision for the service.
The NHS does not need another structural reorganisation of the kind that it has seen too often over the last 15 years. But it does need to hear the unambiguous call for change that other public services have heard in this Parliament.