Andrew Lansley’s health reforms, we report this morning, are bitterly disliked by doctors. In response to a letter signed by 56 medics saying that his proposals are vital, 365 doctors wrote to our letters page saying that the Health and Social Care Bill 2011 “threatens to derail and fragment the NHS into a collection of competing private providers,” resulting in “hundreds of different organisations pulling against each other leading to fragmentation, chaos and damage to the quality and availability of patient care.” A Royal College of General Practitioners survey, recently, found that 90 per cent of GPs opposed the changes; an independent poll of NHS staff found 71 per cent against; the British Medical Journal, Health Service Journal, and Nursing Times published a joint editorial describing the bill as an “unholy mess”.
What’s really weird about it, though, is that no one seems to know what Lansley is doing, why he is doing it, and whether what he has done so far is even legal.
In a beautifully scathing piece for the BMJ last month, Prof Martin McKee, a professor of public health at the London School of Hygiene and Tropical Medicine, asked all those three questions. He says that Malcolm Grant, chairman of the National Commissioning Board, which assesses the NHS’s goals and outcomes, describes the Bill as “completely unintelligible”. The Secretary of State for Health says that people simply don’t understand it, but Prof McKee writes: “I have tried very hard, as have some of my cleverer colleagues, but no matter how hard we try, we always end up concluding that the bill means something quite different from what the secretary of state says it does.”
But let’s imagine, then, that only Mr Lansley can understand the bill, but that nonetheless it is well designed to achieve what it is meant to achieve. What precisely is it meant to achieve?
Mr Lansley says that British is lagging behind other industrialised nations in its healthcare outcomes. But, says Prof McKee, the evidence he has provided to support this claim is inadequate: “one independent source after another, from the Commonwealth Fund in the United States to the Organisation for Economic Co-operation and Development (OECD), has produced reports showing that while the UK once lagged behind other countries, when the amount of money spent on it was among the lowest of any industrialised country, it is now improving at a faster rate than almost anywhere else… What’s more, on many indicators, such as coordination of care, the NHS outperforms all the rest.” The heart-attack deaths evidence used to push the bill was “totally discredited”, he says, and it is noticeable that in this paper recently we reported that the number of fatal heart attacks in Britain has halved in just eight years, and is two-thirds lower than it was in 1980. Just five per cent of British adults have diabetes, compared to 10 per cent of Americans. The NHS is doing well.
More worryingly still, as The Guardian reported late last year, it would be doing even better if we didn’t keep taking it apart and putting it back together again. Mark Pearson, head of health at the OECD, said: “The UK is one of the best performers in the world. But outcomes are not what you expect because there is a big reform every five years. We calculate that each reform costs two years of improvements in quality. No country reforms its health service as frequently as the UK.” Essentially, it ain’t broke, yet we keep fixing it. Pearson again: “The NHS is so central to the political process that every politician has to promise to improve the NHS. But there’s no big reform that will improve it. Better to let it bed down and tinker rather than wondering about more or less competition. It is less the type of system that counts, but rather how it is managed.”
And, in a bitterly entertaining twist, Mr Lansley is going ahead with his changes, despite the fact that the health bill has not yet been passed into law. “Indeed, the government’s main justification for passing the bill now seems to be that the bill is already being implemented and it is impossible to go back,” says Prof McKee, who wonders whether this constitutes contempt of parliament.
“I realise that my bewilderment may simply be a consequence of my own failure to understand the insights that have been granted to wiser and more learned individuals than myself,” sighs Prof McKee, and of course I have to echo those sentiments. Maybe Mr Lansley knows precisely what he is doing and the legal basis for doing it. But the fact remains that the NHS is not in dire need of fixing, and that fixing in general does more harm than good. It’s also a strange political decision: as the doctor and journalist Ben Goldacre tweeted recently, “Destroying the NHS is the one thing almost everyone, regardless of affiliation, fears about a Tory government, and they’re doing it. Very odd choice. The NHS will ruin the Tories.” Hopefully, before they ruin the NHS.