Greater patient involvement in planning, a key aim of the NHS changes, has also failed to materialise since the introduction of a 'managed market' in health care two years ago.
A survey of 117 district managers by the National Association of Health Authorities and Trusts found that health authority purchasers relied on family doctors to test consumer opinion. Patients themselves had no influence on the placing of contracts with hospital providers.
'The views of local residents, whether expressed through the community health council or through patient surveys, remained of low importance,' it said.
Although managers said they had become more proficient in the negotiation of contracts over the last year, many admitted their knowledge of areas such as health economics, information technology and consumer research was sketchy. However, the biggest worries among those responsible for buying health services for NHS patients concern funding and the rapid pace of re-organisation.
Despite one of the most generous public spending settlements for years last autumn, 69 per cent of managers still perceive underfunding as a fundamental problem that cannot be solved by splitting the NHS into purchasers and providers of health services.
Perceived benefits of the re- organisation included better relations with general practitioners, more accountability and improved monitoring of costs and performance. The most commonly cited drawbacks were increased administrative costs and added bureaucracy, diverting resources from patient care. One manager felt that implementation of the NHS changes had been rushed for political reasons, had overwhelmed staff and brought 'no major instant successes'.
Many managers regarded GP fundholding as 'ill-thought through' and felt it tended to 'undermine a cohesive approach to health planning'. The report went on: 'The concentration on short- term gains, as a result of the politicisation of the NHS was seen as a distinct drawback.'
Some claimed that self-governing NHS trusts were showing signs of 'ditching patients that were difficult or costly'. Other criticisms were that the changes had reduced patient choice and drained purchasing authorities of key staff.
The sample of NHS managers was asked whether it was necessary to have a market to obtain the benefits of a purchaser-provider split. Although 56 per cent agreed a market was needed, one in three thought it unnecessary.
David Blunkett, Labour's health spokesman, said the report demonstrated the Government's failure, in its NHS overhaul, to address health care problems. 'The changes are simply not delivering the goods. It is time for the Government to completely reassess the impact of their 'reforms' on the quality of the nation's health services.'
Implementing the Reforms: a second survey of district general managers; NAHAT Publications Department, Birmingham Research Park, Vincent Drive, Birmingham B15 2SQ.Reuse content