Government must assess impact of NHS reform

The government is taking a 'tremendous' risk in overhauling the NHS without evaluating the impact of proposed changes, according to a leading US academic.

Professor Starfield: 'Reforms should be piloted to assess their impact' (Photograph: SPL)
Professor Starfield: 'Reforms should be piloted to assess their impact' (Photograph: SPL)

Professor Barbara Starfield, a researcher at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, spoke to GP about her concerns shortly before her sudden death last week.

Professor Starfield's research on the importance of general practice to healthcare systems was key in influencing the former Labour government's decision to boost primary care funding.

Her studies on the impact of general practice on deprived communities were described as 'seminal' by primary care tsar Dr David Colin-Thome.

She told GP there was 'a tremendous risk if you undertake change without evaluating'.

'These reforms, just like all the previous ones, are being done without thought of the consequences, particularly any unintended consequences,' she said.

'There is nothing wrong in trying to reform the system, but you need a publicly accountable system for evaluating the impact of changes,' she said.

Professor Starfield said the reforms should be piloted to assess their impact on patients. The 'tremendous' General Practice Research Database provided an ideal platform to undertake such trials, she said.

But she pointed out that even with a system as open to research opportunities as QOF, it had proved hard to demonstrate benefits of interventions.

She said money needed to be spent on researching the best ways to improve healthcare delivery. 'We don't have a lot of information about what we should be doing. We should be spending money trying to understand what we should be doing differently in the health system.'

Professor Starfield said research especially needed to look at the treatment of patients with comorbidities.

'The adverse effects of poly-pharmacy haven't been studied,' she said. 'We need to think about how we treat patients, rather than disease minutiae.'

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