Jeremy Laurance: Why can't ministers leave the NHS to do its best for patients?

The challenge facing the NHS behemoth is how to squeeze £20bn-worth of extra services out of existing resources while implementing what some call the biggest reform of the organisation since its inception over 60 years ago.

The commonest complaint from those who work in the organisation is that it is being reformed so often staff are never left to get on with the job they do best – treating patients. The NHS is our most popular national institution – but ministers cannot leave it alone.

As each new reform succeeds the last, staff become preoccupied with their jobs and their future prospects, and arguing about structures. There is never a chance, they say, for the existing arrangement to bed down and prove itself before.

After the previous Tory government introduced the internal market and GP fundholding in the 1990s, Labour moved to eliminate them in 1997. Elements of both reappeared after 2000 with the launch of NHS Foundation Trusts – which could offer new services, compete with rival trusts and keep any surplus – and Primary Care Trusts which controlled GPs and introduced practice-based commissioning, giving family doctors a (tentative) say in what services were purchased for their patients. In 2006, the number of PCTs was halved from around 302 to 152, causing further disruption. Yesterday's White Paper heralds another convulsion. As GPs prepare to take on their new responsibilities, NHS trusts plan how to deal with hundreds of GP consortia and PCT staff ponder their job prospects in 2013, they must also respond to demands for a major efficiency drive. Though spared the Treasury axe, the £20bn efficiency savings demanded of the NHS over the next four years is a tough challenge. Can the organisation pull off both tasks at once?

The independent think-tank Civitas sees trouble ahead. It says the upheaval will damage the NHS just at the moment when it can least afford it. It predicts a one-year dip in performance in absolute terms and says it will set the NHS back three years.

James Gubb, director of its health unit, says: "The NHS is facing the most difficult financial time in its history. Now is not the time for ripping up internal structures yet again on scant evidence but for focussing minds on the task ahead and getting behind the difficult decisions PCT's will have to make."

Merging PCTs had a disastrous effect on their quality rating in 2006, with the proportion judged "good" or "excellent" falling from 34 per cent to 12 per cent in the following year. Yet among those that did not merge, the proportion scoring good or excellent rose over the same period. It took three years for the merged PCTs to catch up with the non-merged.

The starkest warning is from Mid-Staffordshire, where five PCTs merged, which lost sight of what was going wrong at the local trust – Staffordshire Hospital – later billed the worst NHS scandal where there were hundreds of excess deaths attributed to "apalling" standards and which is now the subject of a public inquiry.

Julian Le Grand, professor of health policy at the London School of Economics, disagrees. The changes planned by the coalition Government build on market reforms, including GP fundholding, introduced by the previous Tory government 20 years ago and reinvented by Labour as "practice-based commissioning", the forerunner of Mr Lansley's GP commissioning consortia.

Professor Le Grand said: "It is not actually a massive revolution. Quite a lot is already in place. The NHS is not under threat from massive spending cuts. We need to keep things in proportion. I believe market-oriented reforms have worked. If we are moving to GP commissioning my belief is it will increase competitive pressure. I think it is the way forward."


1988 Kenneth Clarke introduces the internal market

1991 William Waldegrave introduces GP fundholding

1998 Frank Dobson abolishes GP fundholding and the internal market

2001 Alan Milburn introduces primary care trusts

2006 Patricia Hewitt halves the number of primary care trusts

2010 Andrew Lansley brings in GP commissioning consortia

ebookA delicious collection of 50 meaty main courses
Life and Style
ebookNow available in paperback
  • Get to the point
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Ashdown Group: Marketing Manager (B2B) - Romford - £40,000 + car

    £35000 - £40000 per annum + car and benefits: Ashdown Group: Marketing Manager...

    Ashdown Group: Helpdesk Analyst - Devon - £20,000

    £18000 - £20000 per annum: Ashdown Group: Helpdesk Analyst - Devon - £20,000 ...

    Ashdown Group: Data Scientist - London - £50,000 + bonus

    £35000 - £50000 per annum + generous bonus: Ashdown Group: Business Analytics ...

    Ashdown Group: IT Project Coordinator (Software Development) - Kingston

    £45000 - £50000 per annum: Ashdown Group: IT Project Coordinator (Software Dev...

    Day In a Page

    General Election 2015: ‘We will not sit down with Nicola Sturgeon’, says Ed Balls

    'We will not sit down with Nicola Sturgeon'

    In an exclusive interview, Ed Balls says he won't negotiate his first Budget with SNP MPs - even if Labour need their votes to secure its passage
    VE Day 70th anniversary: How ordinary Britons celebrated the end of war in Europe

    How ordinary Britons celebrated VE Day

    Our perception of VE Day usually involves crowds of giddy Britons casting off the shackles of war with gay abandon. The truth was more nuanced
    They came in with William Caxton's printing press, but typefaces still matter in the digital age

    Typefaces still matter in the digital age

    A new typeface once took years to create, now thousands are available at the click of a drop-down menu. So why do most of us still rely on the old classics, asks Meg Carter?
    Discovery of 'missing link' between the two main life-forms on Earth could explain evolution of animals, say scientists

    'Missing link' between Earth's two life-forms found

    New microbial species tells us something about our dark past, say scientists
    The Pan Am Experience is a 'flight' back to the 1970s that never takes off - at least, not literally

    Pan Am Experience: A 'flight' back to the 70s

    Tim Walker checks in and checks out a four-hour journey with a difference
    Humans aren't alone in indulging in politics - it's everywhere in the animal world

    Humans aren't alone in indulging in politics

    Voting, mutual back-scratching, coups and charismatic leaders - it's everywhere in the animal world
    Crisp sales are in decline - but this tasty trivia might tempt back the turncoats

    Crisp sales are in decline

    As a nation we're filling up on popcorn and pitta chips and forsaking their potato-based predecessors
    Ronald McDonald the muse? Why Banksy, Ron English and Keith Coventry are lovin' Maccy D's

    Ronald McDonald the muse

    A new wave of artists is taking inspiration from the fast food chain
    13 best picnic blankets

    13 best picnic blankets

    Dine al fresco without the grass stains and damp bottoms with something from our pick of picnic rugs
    Barcelona 3 Bayern Munich 0 player ratings: Lionel Messi scores twice - but does he score highest in our ratings?

    Barcelona vs Bayern Munich player ratings

    Lionel Messi scores twice - but does he score highest in our ratings?
    Martin Guptill: Explosive New Zealand batsman who sets the range for Kiwis' big guns

    Explosive batsman who sets the range for Kiwis' big guns

    Martin Guptill has smashed early runs for Derbyshire and tells Richard Edwards to expect more from the 'freakish' Brendon McCullum and his buoyant team during their tour of England
    General Election 2015: Ed Miliband's unlikely journey from hapless geek to heart-throb

    Miliband's unlikely journey from hapless geek to heart-throb

    He was meant to be Labour's biggest handicap - but has become almost an asset
    General Election 2015: A guide to the smaller parties, from the the National Health Action Party to the Church of the Militant Elvis Party

    On the margins

    From Militant Elvis to Women's Equality: a guide to the underdogs standing in the election
    Amr Darrag: Ex-Muslim Brotherhood minister in exile still believes Egypt's military regime can be replaced with 'moderate' Islamic rule

    'This is the battle of young Egypt for the future of our country'

    Ex-Muslim Brotherhood minister Amr Darrag still believes the opposition can rid Egypt of its military regime and replace it with 'moderate' Islamic rule, he tells Robert Fisk
    Why patients must rely less on doctors: Improving our own health is the 'blockbuster drug of the century'

    Why patients must rely less on doctors

    Improving our own health is the 'blockbuster drug of the century'