NHS ‘entering treacherous waters’
pharmafile | December 3, 2012 | News story | Sales and Marketing | Ham, NHS, coalition, king's fund, reforms
A leading think tank has marked the coalition government’s health policy with what amounts to a C+ in its mid-term report, but warned that the NHS still faces huge challenges.
The King’s Fund report suggests that NHS performance in England is ‘holding up well’ in most areas – but says some trusts are in financial difficulty and face problems maintaining the quality of their services.
It focuses on eight aspects of healthcare: access, patient safety, promoting health, managing long-term conditions, clinical effectiveness, patient experience, equity and efficiency.
“With the prospect of several more years of austerity and further cuts in social care budgets, the NHS is entering treacherous waters,” says King’s Fund chief executive Chris Ham.
“The risks for patient care could hardly be higher,” he adds.
The way the government’s focus on outcomes rather than performance management is implemented, along with its desire to improve data transparency and give greater control to local doctors, will be crucial to future success.
However, the authors say that much of the data they used relates to 2010-11, making it ‘too early to judge’ whether the NHS has been able to hold on to progress made over the last decade.
With major structural change brought about by the Health and Social Care Act, the loss of experienced NHS managers, pressure to achieve £20 billion of productivity savings by 2015 and reduced spending on social services: the jury remains out, the report says.
‘Cracks are emerging,’ the King’s Fund believes, “with longer waiting times in accident and emergency, and the financial difficulties of more providers being exposed”.
There are also concerns about how hospitals provide emotional support and still questions over the dignity with which patients are treated. Also, while smoking rates fall and child obesity is ‘stabilising’, excess alcohol consumption and adult obesity are rising.
Similarly, mortality rates from cancer and cardiovascular disease have fallen but the UK still has relatively high levels of avoidable deaths, and health inequalities remain a real problem.
Having battled in the first half of its tenure to push through radical legislative change, the government now has to manage the nuts and bolts of the changes to make them work, the report says.
“Much hinges on the ability of the new ministerial team to work with leaders at all levels, and to engage thousands of clinical staff in rising to this challenge,” it adds.
The report is also scathing about what it calls “simplistic approaches to driving change in the NHS”. These are characterised as alternating “between top down versus bottom up, competition versus collaboration and a range of other false dichotomies”.
Instead, effective change will require a nuanced approach, for example empowering frontline doctors while strengthening organisational leadership, or supporting competition in some areas and encouraging collaboration in others.
Above all, the government must implement ‘overdue’ service changes and new models of care “at a scale and pace never seen before”, the report concludes.
Adam Hill
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