A major study by the think tank of the impact of the 2013 Health and Social Care Act concluded that the complex organisational changes came at a time when the NHS should have been focused on tackling growing pressures and an unprecedented funding squeeze.
The report, The NHS under a coalition government - Part one: NHS reform, found that greater involvement of GPs in commissioning was a positive development from the changes, which were opposed by GP leaders in the BMA and RCGP.
The report said the new structure of the NHS in England was ‘unwieldy’ with national leadership fractured, a ‘bewilderingly complex’ regulatory system, and a ‘strategic vacuum’.
Reforms created uncertainty
It said predictions and claims of large-scale privatisation had been exaggerated, but that the emphasis on competition created uncertainty and complexity.
It criticised the fragmentation of commissioning between CCGs and NHS England, which it said was weighed down by responsibilities.
King’s Fund chief executive Chris Ham said: 'Historians will not be kind in their assessment of the coalition government's record on NHS reform.
‘The first three years were wasted on major organisational changes when the NHS should have been concentrating on growing financial and service pressures – this was a strategic error. Only latterly has the government adopted a more positive focus on improving patient care and achieving closer integration of services. Politicians should be wary of ever again embarking on such a sweeping and complicated reorganisation of the NHS.’
Change in emphasis
The report did welcome a change in emphasis in the second half of the coalition’s term, away from competition and choice and towards improving patient care and service integration.
A spokesman for Jeremy Hunt said: ‘We welcome the King’s Fund’s recognition that the government’s focus on patient safety and integrated care is right for the NHS’ future. This independent assessment also puts paid to Ed Miliband’s myth that the reforms were about privatisation, and highlights why both the public and the health sector should be wary of Labour’s plans for upheaval and reorganisation.’
NHS Confederation director of policy Dr Johnny Marshall, a practising GP, said it was time to look forward and the next government must avoid major structural change. ‘The health policies of the next government must focus on giving local organisations the freedom to tackle the big issues which face the health service,' he said.
‘Key to making these changes is stability. The next government must avoid at all costs a top-down reorganisation of NHS structures. We need to build upon the progress which is being made locally by the NHS, including by clinical commissioners, in transforming care, not waste time with any disruptive restructuring mandated by Whitehall.’