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Tuesday 22nd May 2018

The £3bn roundabout of reform

5th March 2007

The seemingly constant and conflicting reforms in the NHS over the past decade have left the heath service heading for meltdown.


In the Sunday Telegraph, Liam Halligan takes us on a journey through the past decade of reorganisation only to find the service has come back to where it started from.

We begin with the abolition of GP fundholders in 1997 and introduction of non market-driven primary care groups. Later these became trusts – a slide back towards the market. Today's practice-based commissioning is a whole-hearted return to GP fundholders.

At the higher level, the government got rid of the eight regional health authorities, split them up into 28 smaller strategic health authorities, only to merge them again into the 10 SHAs we have today.

Beneath the regional health authorities, the 100 local health authorities became 480 primary care groups, only to be partially merged into first 303 and now 152 primary care trusts.

But that’s not all. ‘In terms of coherence, experts say that New Labour's successive reforms conflict and clash with one another,’ he writes.

Hospitals now face many masters: the PCTs that commission services, the public who can choose where they go under the patient choice agenda and the government that dictates their performance through targets. Meanwhile the spirit of collaboration doesn’t sit within the new competitive marketplace.

Health academic and former trust chairman Prof Calum Paton puts the cost of all this change at £3bn. The NHS has also become mired in layers of bureaucracy along the way, costing around £1.5bn a year to manage, about the same as today’s NHS deficit.

Doctors agree the reforms have come full circle, and have served only to distract the NHS, and its frustrated clinicians, from the job in hand. As the new letterheads and logos are ordered, patient care is put on the backburner.

He writes: 'I put it to the BMA chairman that this 'tyranny of health reform' is a uniquely British disease. "Well," he replied, "the NHS is a uniquely British organisation."'

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