A new report published by independent think-tank Reform has painted a rather gloomy picture of the future of the National Health Service, claiming that the government’s Service revamp could end up delivering poor quality at an extra cost of £20 billion a year.

While the report NHS Reform: national mantra, not local reality applauds the government’s ongoing commitment to health service reform, it says ministers are in denial about how much progress is really being achieved, particularly by flagship initiatives such as patient choice and independent commissioning.

Speaking on BBC Radio Four’s Today programme yesterday, one of the report’s authors, Nick Bosanquet, Professor of Health Policy of Imperial College London, described 2008 as a “crucial year” for the NHS, and said that while there are several good proposals in the government’s current operating framework, “they are not being followed through on the ground”.

According to Bosanquet, reform policies across the board are not progressing quickly enough, and he singled out as prime examples the slow uptake of independent commissioning and the less-than-expected role of independent sector centres, which, he claims, are being used “as a sort of putty to plug up the gaps rather than as a dynamic programme to give people choice and increase competition”.

In response, Nigel Edwards, Policy Director at the NHS Confederation, agreed that the progress of the reform programme does indeed need to shift up a gear, but he stressed that “very large changes in very large systems do take time” and that the need for “instant gratification” was unrealistic.

But the report insists that, if things continue as they are, the NHS might find itself in a situation where poor quality services are being delivered to patients but at an extra cost of £20 billion per year, at a time when taxpayer funding will be tightened.

Economic constitution
NHS Reform: national mantra, not local reality believes that greater productivity, not higher levels of cash, is the solution to the problem: “The key is an economic constitution which requires value for money and guarantees patient choice and a diversity of providers”, it states.

“The Department of Health’s strategic challenge is to transform the quality of NHS care within a foreseeable future of tightly limited resources,” Bosanquet adds. “The NHS does not need a ‘charter’ which amounts to a statement of good intentions. It needs an economic constitution which gives every level of the service the duty to achieve value for money.”

The report concludes that if this were the “key conclusion” of the Department of Health’s current landmark NHS review, “it would deliver significant improvement within 18 months”.