Sir Roger Boyle leaves his post as the NHS's National Director for Heart Disease and Stroke with a bang – and a most unwelcome one as far as Andrew Lansley is concerned. In his interview with this newspaper today, Sir Roger presents an extensive charge sheet against the Health Secretary.
He argues that Mr Lansley has deliberately downplayed the NHS's successes in improving health outcomes over the past decade in order to justify a revolutionary structural overhaul. Sir Roger also accuses the Health Secretary of packing the NHS Future Forum – which was set up earlier this year to review the NHS and Social Care Bill – with individuals who would ultimately give him what he wanted. Despite the Future Forum's modifications of the Bill, Sir Roger argues that 80 per cent of Mr Lansley's original plan has been retained.
Sir Roger also thinks that the plan itself is fundamentally flawed, pointing out that impressive improvements in his own area of cardiovascular care have come not from the introduction of private sector competition, but from enhanced collaboration within the NHS. He argues that there is a lack of evidence to support Mr Lansley's contention that private-sector involvement in the NHS will drive up efficiency and quality. The US market system, with its spiralling costs, he suggests, is not a model that Britain should seek to emulate. He also predicts that increased competition will simply cause costs to rise.
So is this blistering critique justified? Up to a point. Sir Roger seems to underestimate the extent to which the NHS is failing to deliver value for money for taxpayers and patients. It is true there have been some impressive health outcome improvements in Sir Roger's domain of heart disease. Waiting times have been slashed and the death rate has halved over the past decade. But half of these improvements are judged to be attributable to changes in lifestyles, in particular falling smoking rates. Moreover, there are other areas of the NHS, such as orthopaedics, where private-sector involvement has helped to drive down waiting times. And there is evidence to suggest that an increasing role for private-sector providers in some areas would drive improvements in outcomes.
Yet Sir Roger's broad criticisms of Mr Lansley's approach are, sadly, all too accurate. The Health Secretary has rushed into a hugely ambitious reform programme in an ideologically blinkered manner. He has not assembled a compelling evidence base to justify particular structural changes such as transferring commissioning powers to GPs. And he has manifestly failed to make a convincing case to either the public or the medical profession for what he is attempting to do.
The NHS must, as Mr Lansley often argues, become more efficient if it is to deliver the same quality of outcomes over this Parliament and beyond. And the introduction of the private sector is undoubtedly a way of helping to achieve that goal. But there is a balance. The private sector must be used judiciously, not regarded as a panacea. And the design of regulation to accompany increased competition is of vital importance. The open question is whether Mr Lansley, after his dreadful year in office, can be relied upon to strike that balance.