The recent damning report by the King’s Fund “think tank” into NHS reforms, and the news that NHS providers have voted against the NHS watch-dog Monitor’s tariff for NHS services, show growing dissatisfaction with the government’s handling of the NHS.
In an unusually outspoken attack on the government, the King’s Fund claims David Cameron exhibited a “failure to exercise due diligence” when allowing Andrew Lansley’s reform proposals to become law. Despite being firmly in favour of a market in healthcare, they describe the government's reforms as a shambles of mismanagement, over complication and confusion.
The report says the reforms have weakened the general understanding of how the NHS functions. It describes a healthcare system where “governance and accountability have become more complex” with the potential for unaccountable power to run amok.
While shying away from placing the current crisis in our hospitals directly at the feet of the Health and Social Care Act, they say “it seems likely that the massive organisational changes that resulted from the reforms contributed to widespread financial distress and failure to hit key targets for patient care.”
They highlight the findings of the Berwick report on Patient Safety, which suggests the complicated model of multiple regulators, all at arm’s length from the Department of Health, sitting alongside NHS England, needs to be streamlined.”
The Berwick report on Patient Safety (2013) says “The current regulatory system is bewilderingly complex and prone to both overlaps and gaps between different agencies. It should be simplified.’
Yet the report is not entirely critical of the Conservative Party. It casts Jeremy Hunt as a damage limiter and promoter of patient safety — at odds entirely with his role in the attempted downgrading of Lewisham Hospital’s Accident & Emergency and Maternity Departments, which required a Judicial Review for them to be saved.
The government has now changed the law to prevent a defeat such as the one they suffered at Lewisham, and has openly said the new law would reduce the ability of the local community to have a say in how health services were provided.
What is the services tariff? This tariff is the amount each NHS funded provider will be paid for doing work within the NHS.
75.1% of providers lodged formal objections to the proposed tariff by Monitor, throwing planning of budgets within the NHS, and ultimately the government, into disarray.
The NHS providers feel that they can not continue to provide vital services while budgets continue to shrink.
Over £20 billion has been removed from health service budgets in this manner during the coalition government.
The downward trend is no longer sustainable, particularly as large parts of this cost saving have come direct from workers’ wages, in the form of below-inflation wage rises and staffing cuts, which even hospital managers realise can’t continue forever.
Monitor’s role as the all powerful overseer of finances is putting incredible strain on our health service. As hospitals struggle with a growing bed crisis, the solution from the financial watchdog is to cut the money paid out for some accident and emergency admissions to half of what it really costs. This is not a government body in touch with the realities on the ground.
By attempting to privatise and reduce funding for our NHS at the same time, the government have created a system that nobody trusts or believes in, without the money to fund it properly. We are now beginning to see the endgame for universal service provision.
In December 2014 North East and West Devon Clinical Commissioning Group announced a number of cost saving changes, stating that services such as a second hearing aid were not cost effective.
The reality of a system that is unaccountable, ungoverned and under resourced is that services that we used to think of as routine will disappear and we will not know which way to turn, which unelected government quango to blame, or how we can get ourselves out of this mess.
The King’s Fund now says we must focus on “the physiology of the NHS rather than its anatomy”. This is obvious nonsense. Politicians have spent at least the last 10 years dissecting our health service and have created a neo-liberal monster. It is only with a thorough understanding of what made our NHS remarkable and unique at its inception that we will save it now.
We must remove the healthcare market and re-imagine a National Health Service based on social solidarity fit for today’s health needs. Those currently entrusted with managing the NHS are not up to the task.