NHS reform: the risks of jumping on the spot again

Abstract

Tragic events in hospitals in Mid-Staffordshire and Morecambe Bay, together with another round of structural ‘re-disorganization’ have fuelled speculation about the long-term viability of the National Health Service (NHS). Elected to have no ‘top down’ reform of the NHS the coalition government has implemented radical evidence-free reforms focused on the creation of a quango, NHS England, with responsibility for strategic system management and the commissioning of specialist services. One hundred and fifty-two primary care trusts have been replaced by 210 clinical commissioning groups managed by general practitioners transmogrified into managers of 60% of the NHS budget. The legislation underpinning these changes is complex and has created speculation that healthcare provision and perhaps its finance may be privatized. Privatization is likely to sustain the inefficiencies of the NHS, with potentially much greater inequity in access to patient care. Let's compare the actual performance of each system, while bearing in mind the ideals of each of the protagonists.1 In both the provision and finance of healthcare, public and private systems often have common failings.