The editors of three leading healthcare publications warn today that the NHS will need another overhaul in five years, and call for a public debate on its future to “salvage some good” from the government’s “damaging” reforms.
In an editorial published simultaneously in their journals, the editors of the British Medical Journal (BMJ), the Health Service Journal and Nursing Times stress that the NHS “is far too important to be left at the mercy of ideological and incompetent intervention,” and that “we must make sure that nothing like this ever happens again.”
As part of this process, they suggest that Parliament should now establish an independently-appointed standing commission to initiate “a mature and informed national discussion on the future of our national health system.”
While health professional groups differ in their stance on the bill, “there can be no doubting the overwhelming sense of distress and lack of confidence in the government’s plans among those who must deliver the service,” write the editors – the BMJ’s Fiona Godlee, HSJ’s Alastair McLellan and Nursing Times’ Jenni Middleton.
“Through a combination of poor political judgement and reluctance to engage with criticism, a set of (mostly) reasonable objectives morphed into an old-fashioned, top-down reorganisation. It also resulted in a bloated and opaque piece of legislation, whose goals could have largely been achieved by other, more effective means,” they write.
Once the Health and Social Care Bill becomes law, “we will still be in the dark about how much of the new system will work,” and “we will have an unstable system that is only partially fit for purpose,” the three editors warn. They also forecast that “another major NHS reform programme is guaranteed within five years.”
It is possible, they say, to feel sorry for Health Secretary Andrew Lansley, when – after years of being told that politicians should get out of the NHS – his proposals to loosen the Secretary’s grip on the NHS were thrown back in his face. But, they argue: “those proposals were poorly thought-through, and the government amendment restoring his responsibility for the NHS has failed to reassure some critics.”
The editors call for “a broad public debate on the principles that should underpin the NHS, how decisions on priorities should be made in a cash-limited system and what role clinicians and private-sector organisations could and should play.”
Such a debate will require restraint on behalf of all involved, if it is to escape from being characterised yet again by polarised views, (often disguised) vested interest, political point-scoring and conspiracy theories to be benefit of none, they emphasise, and conclude: ‘let us try to salvage some good from this damaging upheaval and resolve never to repeat it.”
A second editorial published in the BMJ today says that abandoning the Health and Social Care Bill now would save just over £1 billion in 2013. Dropping the Bill would also put an end to the prolonged and damaging period of organisational uncertainty in the NHS and allow Service organisations to focus on improving efficiency and productivity and sustaining performance in the face of years of financial austerity, writes Kieran Walshe, professor of health policy and management at Manchester Business School.
He suggests that, while this could be politically painful, the government could argue that, in the special economic circumstances of the day, it makes sense to drop the Bill, and point out that the substantially savings in NHS economic costs which it promised have already been made.
Ministers might get some credit from the media and the public for listening and learning, and they would also neutralise an issue which has becoming increasingly politically toxic for them, he adds.
“They could then plan to accomplish much of their intended reform agenda – greater patient choice, more GP involvement in commissioning, increased plurality and competition in healthcare provision – using existing legislative provisions. And the NHS could get on with delivering healthcare to patients, and the serious business of finding ways to do more with less,” Prof Walshe concludes.
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