Leading Thinktank The Kings Fund Condemns Tory 'Reforms' of NHS

The coalition’s shake-up of the NHS was misguided, deepened the growing problems facing A&E units and left it weaker, structurally “incomprehensible” and less able to improve care for patients, according to a leading health thinktank.

In an assessment of the government’s NHS record, the King’s Fund said that the reorganisation forced through by then health secretary Andrew Lansley in the early period of the coalition was “damaging and distracting” for a health service that should have been preparing for the serious challenges it is now confronting.

Prof Chris Ham, the King’s Fund’s chief executive, 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 services pressures. This was a strategic error.”

As well as its unsparing critique of Lansley, the 80-page assessment of how the NHS has fared under the coalition also accuses David Cameron of making errors that allowed Lansley to press ahead with a “sweeping and complicated” reorganisation of the NHS in England, even though the coalition agreement of May 2010 had specifically ruled one out.

When the health secretary unveiled the health and social care bill in autumn 2010, the influential thinktank’s report concludes that “information asymmetry in Whitehall enabled Lansley’s views to prevail [within the government]. There was no countervailing source of understanding of the NHS elsewhere in Whitehall, the prime minister having dismantled expertise built up by Tony Blair and Gordon Brown in No 10 as part of his drive to pass back power to departmental ministers.

“David Cameron’s failure to exercise due diligence on the reforms would come back to haunt him.”

The huge ensuing controversy – the largest generated by any changes in the NHS – pitted the medical establishment against the coalition. The outcry forced Cameron, in an unprecedented move, to call a “pause” in the bill’s passage and ask a group of experts, the NHS Future Forum, to improve it.

The King’s Fund also says that Lansley’s overhaul, which abolished hundreds of NHS bodies such as primary care trusts and strategic health authorities (SHA):

• Left the structure of the NHS so “complex, confusing and bureaucratic” that the organisation of the service “is not fit for purpose”.

• Wasted the time of NHS bosses, who were “distracted as they were required to rearrange the deckchairs rather than navigate safely past the iceberg” of growing demand for care and the service’s tightest-ever financial squeeze.

• Led to the loss of talented senior NHS leaders by creating an array of new organisations, each responsible for areas such as hospitals or public health, meaning that no one is in overall charge and the NHS now suffers from a leadership vacuum.

It also says that axing the 10 SHAs means that, despite the creation of 211 GP-led clinical commissioning groups, “nobody is in charge locally”, creating a huge risk, especially with the NHS having to undertake fresh changes now to the way it operates in order to remain viable.

But the thinktank’s most damaging criticism is its judgment that the huge disruption the bill unleashed has intensified the NHS’s growing problems in trying to treat patients in A&E or waiting for cancer care or a planned operation within set targets.

“By taking three years to dismantle the old structures and reassemble them into new ones, the government took scarce time and expertise away from efforts to address these [financial and service] pressures.

“Although it is not possible to demonstrate a causal relationship with NHS performance, 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,” the report says.

Ham, one of a number of NHS experts who became part of a Downing Street health “kitchen cabinet” set up because of the controversy, said that “common sense would suggest” there was a link between the Bill and the NHS’s current difficulties.

Stephen Dorrell, the former Tory health secretary who stood down last year as chair of the Commons health select committee, told the Observer that he agreed that the restructuring was the biggest mistake the coalition had made. “The reason I agree with it is partly for the political fallout, but the thing I care most about is the lost opportunity in the health and care system”, he said.

However, the thinktank also says that the Health and Social Care Act, despite increasing competition in the NHS, did not produce the widespread privatisation of NHS services that many critics feared. And it praises the Liberal Democrats, especially care services minister Norman Lamb, for ensuring progress on social care and mental health, and starting the integration of health and social care.

There was also some praise for Jeremy Hunt, who succeeded Lansley in September 2012, who the King’s Fund said had done much better by focusing on safety and quality of care.

Dr Mark Porter, leader of the British Medical Association, said the act had done “profound and intense” damage to the NHS because it prioritised competition over integration. “A BMA survey of doctors found that 95% did not believe the Act had improved the quality of services for patients, with three-quarters believing it has made the delivery of joined-up care more difficult.”

The department of health sidestepped the report’s many criticisms of Lansley’s tenure. Instead, in a short statement, a spokesman for Hunt welcomed “the King’s Fund’s recognition that the government’s focus on patient safety and integrated care is right for the NHS’s future”.

The department also claimed that Burnham’s plans to integrate health and social care as part of a 10-year NHS plan would involve yet another unpopular restructuring. “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”, he added.

Downing Street declined to comment last night and referred questions to the department of health.

Lansley defended his tenure. He said: “The report is silent on the question of whether patient care has been improved, on which the evidence is clear.

“When I was health secretary, year-long waiting times were eliminated, hospital infections dropped to their lowest levels ever, and thousands of lives were saved, and continue to be saved from improved care.

“The NHS is now judged to be the best health service in the world. The number of administrators has fallen, doctors and nurses have risen, productivity has gone up, and waste has been cut by over £5 billion a year.

“Public sector reform has never been a popularity contest, but these reforms will last. The independence of NHS England from national politicians and the leadership of local GP will stand the test of time, and patients will continue to see the results.”

Labour said the King’s Fund had borne out its criticisms at the time.

“Labour warned David Cameron that his reorganisation would damage the NHS and we now have independent authoritative evidence that that is what has happened”, said Andy Burnham, the shadow health secretary. “People will remember patients, nurses, doctors and midwives lining up in their thousands and pleading with the government to call it off. But they ploughed on and plunged the NHS into the chaos we see today”.

http://www.theguardian.com/society/2015/feb/06/nhs-reforms-tories-damaging-thinktank-kings-fund

Get them out before we have no NHS left.

Left wing drivel.

While acknowledging that the reforms have led to “greater marketisation” in the NHS, the King’s Fund said “claims of mass privatisation were and are exaggerated”.
In the first of two reports looking at the Coalition’s record on the NHS, the think-tank welcomed a shift in focus towards patient safety under Mr Lansley’s successor, Jeremy Hunt. This came in the wake of the Francis Report into poor care standards at the Mid Staffordshire NHS Trust, as ministers sought to distance themselves from reforms that came to be widely regarded in Government as a major error.
“Jeremy Hunt has taken the lead on damage limitation, studiously ignoring many of the reforms promoted by his predecessor (rarely mentioning competition, for example) and staking his claim as the defender of patients’ interests,” the report states.
The report also praised recent efforts to integrate health and social care services, amid concerns that cuts to care in the community and at home for elderly patients are creating huge pressures for hospitals.
A spokesman for Mr Hunt said the King’s Fund report highlighted “why both the public and the health sector should be wary of Labour’s plans for upheaval and reorganisation.”

http://www.independent.co.uk/life-style/health-and-families/health-news/andrew-lansleys-damaging-reforms-at-root-of-the-current-nhs-crisis-10027314.html

risingsun wrote:The coalition’s shake-up of the NHS was misguided, deepened the growing problems facing A&E units and left it weaker, structurally “incomprehensible” and less able to improve care for patients, according to a leading health thinktank.

In an assessment of the government’s NHS record, the King’s Fund said that the reorganisation forced through by then health secretary Andrew Lansley in the early period of the coalition was “damaging and distracting” for a health service that should have been preparing for the serious challenges it is now confronting.

Prof Chris Ham, the King’s Fund’s chief executive, 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 services pressures. This was a strategic error.”

As well as its unsparing critique of Lansley, the 80-page assessment of how the NHS has fared under the coalition also accuses David Cameron of making errors that allowed Lansley to press ahead with a “sweeping and complicated” reorganisation of the NHS in England, even though the coalition agreement of May 2010 had specifically ruled one out.

When the health secretary unveiled the health and social care bill in autumn 2010, the influential thinktank’s report concludes that “information asymmetry in Whitehall enabled Lansley’s views to prevail [within the government]. There was no countervailing source of understanding of the NHS elsewhere in Whitehall, the prime minister having dismantled expertise built up by Tony Blair and Gordon Brown in No 10 as part of his drive to pass back power to departmental ministers.

“David Cameron’s failure to exercise due diligence on the reforms would come back to haunt him.”

The huge ensuing controversy – the largest generated by any changes in the NHS – pitted the medical establishment against the coalition. The outcry forced Cameron, in an unprecedented move, to call a “pause” in the bill’s passage and ask a group of experts, the NHS Future Forum, to improve it.

The King’s Fund also says that Lansley’s overhaul, which abolished hundreds of NHS bodies such as primary care trusts and strategic health authorities (SHA):

• Left the structure of the NHS so “complex, confusing and bureaucratic” that the organisation of the service “is not fit for purpose”.

• Wasted the time of NHS bosses, who were “distracted as they were required to rearrange the deckchairs rather than navigate safely past the iceberg” of growing demand for care and the service’s tightest-ever financial squeeze.

• Led to the loss of talented senior NHS leaders by creating an array of new organisations, each responsible for areas such as hospitals or public health, meaning that no one is in overall charge and the NHS now suffers from a leadership vacuum.

It also says that axing the 10 SHAs means that, despite the creation of 211 GP-led clinical commissioning groups, “nobody is in charge locally”, creating a huge risk, especially with the NHS having to undertake fresh changes now to the way it operates in order to remain viable.

But the thinktank’s most damaging criticism is its judgment that the huge disruption the bill unleashed has intensified the NHS’s growing problems in trying to treat patients in A&E or waiting for cancer care or a planned operation within set targets.

“By taking three years to dismantle the old structures and reassemble them into new ones, the government took scarce time and expertise away from efforts to address these [financial and service] pressures.

“Although it is not possible to demonstrate a causal relationship with NHS performance, 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,” the report says.

Ham, one of a number of NHS experts who became part of a Downing Street health “kitchen cabinet” set up because of the controversy, said that “common sense would suggest” there was a link between the Bill and the NHS’s current difficulties.

Stephen Dorrell, the former Tory health secretary who stood down last year as chair of the Commons health select committee, told the Observer that he agreed that the restructuring was the biggest mistake the coalition had made. “The reason I agree with it is partly for the political fallout, but the thing I care most about is the lost opportunity in the health and care system”, he said.

However, the thinktank also says that the Health and Social Care Act, despite increasing competition in the NHS, did not produce the widespread privatisation of NHS services that many critics feared. And it praises the Liberal Democrats, especially care services minister Norman Lamb, for ensuring progress on social care and mental health, and starting the integration of health and social care.

There was also some praise for Jeremy Hunt, who succeeded Lansley in September 2012, who the King’s Fund said had done much better by focusing on safety and quality of care.

Dr Mark Porter, leader of the British Medical Association, said the act had done “profound and intense” damage to the NHS because it prioritised competition over integration. “A BMA survey of doctors found that 95% did not believe the Act had improved the quality of services for patients, with three-quarters believing it has made the delivery of joined-up care more difficult.”

The department of health sidestepped the report’s many criticisms of Lansley’s tenure. Instead, in a short statement, a spokesman for Hunt welcomed “the King’s Fund’s recognition that the government’s focus on patient safety and integrated care is right for the NHS’s future”.

The department also claimed that Burnham’s plans to integrate health and social care as part of a 10-year NHS plan would involve yet another unpopular restructuring. “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”, he added.

Downing Street declined to comment last night and referred questions to the department of health.

Lansley defended his tenure. He said: “The report is silent on the question of whether patient care has been improved, on which the evidence is clear.

“When I was health secretary, year-long waiting times were eliminated, hospital infections dropped to their lowest levels ever, and thousands of lives were saved, and continue to be saved from improved care.

“The NHS is now judged to be the best health service in the world. The number of administrators has fallen, doctors and nurses have risen, productivity has gone up, and waste has been cut by over £5 billion a year.

“Public sector reform has never been a popularity contest, but these reforms will last. The independence of NHS England from national politicians and the leadership of local GP will stand the test of time, and patients will continue to see the results.”

Labour said the King’s Fund had borne out its criticisms at the time.

“Labour warned David Cameron that his reorganisation would damage the NHS and we now have independent authoritative evidence that that is what has happened”, said Andy Burnham, the shadow health secretary. “People will remember patients, nurses, doctors and midwives lining up in their thousands and pleading with the government to call it off. But they ploughed on and plunged the NHS into the chaos we see today”.

http://www.theguardian.com/society/2015/feb/06/nhs-reforms-tories-damaging-thinktank-kings-fund

Get them out before we have no NHS left.

That is a damning report on what this coalition have done to the NHS. No top down reorganisation trumpeted Dave when it's clear that top down reorganisation is exactly what has happened wrecking any chance that most of the reforms were supposed to make better.

Cherry picking a few good points out of that lot just isn't good enough and anyway several of these are not due to kick in until next year and beyond and the report says meeting them will be extremely challenging.

As the report also says 'this will come back to haunt David Cameron'

Get them out before they get the chance to do even more damage.

Left wing drivel

While acknowledging that the reforms have led to “greater marketisation” in the NHS, the King’s Fund said “claims of mass privatisation were and are exaggerated”.
In the first of two reports looking at the Coalition’s record on the NHS, the think-tank welcomed a shift in focus towards patient safety under Mr Lansley’s successor, Jeremy Hunt. This came in the wake of the Francis Report into poor care standards at the Mid Staffordshire NHS Trust, as ministers sought to distance themselves from reforms that came to be widely regarded in Government as a major error.
“Jeremy Hunt has taken the lead on damage limitation, studiously ignoring many of the reforms promoted by his predecessor (rarely mentioning competition, for example) and staking his claim as the defender of patients’ interests,” the report states.
The report also praised recent efforts to integrate health and social care services, amid concerns that cuts to care in the community and at home for elderly patients are creating huge pressures for hospitals.
A spokesman for Mr Hunt said the King’s Fund report highlighted “why both the public and the health sector should be wary of Labour’s plans for upheaval and reorganisation.”

http://www.independent.co.uk/life-style/health-and-families/health-news/andrew-lansleys-damaging-reforms-at-root-of-the-current-nhs-crisis-10027314.html

Viewpoint: Dr Kailash Chand: Enforcing NHS competition has diverted funding from the frontline

By Dr Kailash Chand on the 6 February 2015

Who can disagree with Professor Chris Ham, chief executive of The King's Fund, when he says: 'Historians will not be kind in their assessment of the coalition government's record on NHS reform, writes BMA deputy chairman Dr Kailash Chand.

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

http://www.gponline.com/viewpoint-dr-kailash-chand-enforcing-nhs-competition-diverted-funding-frontline/article/1332833

Even David Cameron's own brother in law, a top cardiologist, is backing this.

The NHS’s unprecedented decision to put 11 trusts into special measures is likely to have saved hundreds of lives, experts have said. Death rates fell at the trusts after the 2013 intervention, spearheaded by NHS England’s medical director Sir Bruce Keogh in the wake of the Mid Staffordshire hospital trust scandal.

Although difficult to predict from mortality statistics, Roger Taylor, director of research at the Dr Foster group, has published new analysis saying there had been a fall of roughly 450 deaths across the 11 hospitals between August 2013 and June 2014.
Mr Taylor said it was almost certain hundreds of lives had been saved because of the interventions. However it was revealed that at one trust, Tameside Hospital NHS Foundation Trust in Greater Manchester, mortality rates had continued to worsen.
Key contributions include changes in management at the worst-performing hospitals, and the appointment of directors of improvement – an NHS equivalent of the “super-heads” deployed at failing schools.
Tameside, Medway NHS Foundation Trust and East Lancashire Hospitals NHS Trust have all appointed new chief executives in the wake of the Keogh inspections into 14 NHS trusts that had “outlying” high mortality rates, 11 of which were subsequently placed in special measures.
Others replaced key board members, and special measures hospitals were “buddied” with a successful neighbouring hospital.


http://www.independent.co.uk/life-style/health-and-families/health-news/nhs-special-measures-have-saved-hundreds-of-lives-say-experts-10031482.html