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. The question historians would also ask is why the King’s Fund remained quiet during the passage of the NHS bill/Act?
The reforms were predicted to be like a slow train crash at the time, and indeed that has been proven to be the case. The new NHS is now more fragmented than ever before. It has no primacy over provision, and money is squandered over lost causes such as procurement of contracts and fighting competition from within. The bitter pill of privatisation of the NHS was wrapped in the sweetener of championing three issues: patients at the centre of the NHS, changing the emphasis from targets to clinical outcomes, and empowering health professionals (in particular GPs).
Purpose of the NHS Act was to increase the plurality of provision
In practice, this turned out to be an illusory empowerment for GPs and patients, as we had warned at the time. The sole purpose of the NHS Act was to increase the plurality of provision, in particular the introduction of the market philosophy, so that private providers could be enticed to take a slice of the NHS services. This would mean public and private providers could compete against one another, not on the basis of quality, but efficiency savings, which is a euphemism now for a cut in costs. The NHS is already showing signs of cash fatigue, fragmentation and disintegration with no-one accepting or being able to accept responsibility and indeed with chaos at the top of the organisation and no ownership of who the buck should stop with.
I did predict in 2010 that Lansley’s Act would end in tears. Now, after four and half years, the King’s Fund agrees healthcare is in crisis. Markets haven't worked, inspection hasn't worked, demand management has failed, morale is at an all-time low and workforce planning is botched. The major consequences of the Act has been how it views healthcare in England as a business rather than a service. In the last year – more than any other period during my time as a doctor – I’ve seen a combination of years of underfunding and an unstoppable rise in demand really start to bite.
Overstretched services are no longer able to keep up with rising demand: patients face longer waits to see their GPs, who are now conducting 40 million more consultations a year than in 2008; A&E waiting times are some of the worst they’ve been in a decade; waiting lists are at a recent high with millions of people waiting for treatment in hospital. In 2014 the NHS experienced not just a winter crisis, but a spring, summer, autumn crisis as well, with hospitals reaching capacity during the summer months, well before the seasonal spike in demand kicked in.
Despite politicians’ claims that the Act would not lead to privatisation, the last two years have seen creeping privatisation. Enforcing competition in the NHS has not only led to services being fragmented at a time when we need to deliver more joined-up care, but it has also diverted vital funding away from frontline services to costly, complicated tendering processes.
If the King’s Fund is serious in atoning its mistakes, it needs to advocate a health service which is properly funded, adequately staffed, with patients and clinicians in the driving seat. Healthcare which is public, integrated, not a two tier, part-privatised health market. It’s not too late to turn things around, but if we don’t act now it soon will be.
* Dr Chand is BMA deputy chairman