Debating healthcare

Hospital A call to cut the number of beds and possibly shut hospitals to save money was always going to be controversial. Taxpayers will think that if they are ill, a bed should be there for them in their local hospital. This is true – it absolutely should be. But Reform’s proposals, outlined in their new paper Fewer hospitals, more competition, are more nuanced than that to be fair. They outline a case for changing how service is delivered, not simply keeping the same service but heartlessly chucking out hospital beds and closing down wards. They argue that many of the treatments delivered in hospitals can now be delivered at home and in the community through smaller clinics.

The paper also says that despite a huge increase in the annual funding of the NHS – £35bn in 1997 to £102 billion in 2009 – a similar increase in the quality of care has not been delivered. This is in fact true of the entire public sector, which saw productivity fall 3.4 percent between 1997 and 2007, despite a 38 percent increase in inputs. Of this increase in money spent, 40 percent was on the NHS. Our report from 2007, Wasting Lives, also found - through a robust statistical analysis of mortality amenable to health care rates - that despite a big increase in funding relative to other countries, the rate of improvement relative to our European peers hadn’t increased.

Fewer hospitals, more competition points out that funding has been too focussed on basic outputs – more beds, more people employed etc. These are good statistics for politicians to reel off, of course, but according to Reform not changing how services are delivered means that these extra numbers do not bring the benefits they should. It’s part of a larger problem of centralised bureaucracy. Local NHS organisations have very little room for independent decision making, and Reform suggest allowing Primary Care Trusts (PCTs) to retain financial savings, as well as giving patients a choice of PCTs, as opposed to just the GP. The aim is to create competition and give patients choice.

Further, Wasting Lives argued that the NHS was too monopolistic, in that it did not allow patients the option to get part of their treatment from the private sector, if they so wished. We also found that the organisation was at the whim of political management – with none of the Secretaries of State of the last 30 years having the relevant experience to run it. (Incidentally, there would be very few people with the experience of running one of the world’s fourth largest organisation, let alone one specific to the complex delivery of healthcare. All the more reason to decentralise it and encourage a bit of competition.)

At a well-attended event yesterday to launch Reform’s paper, a couple of questions were asked about how recommendations such as these can gain traction in the public debate over NHS reform. ‘Radical’ suggestions tend to get shouted down, dressed as horror stories of politicians mercilessly shutting down wards just to save money. A good response to this question was not really forthcoming from the panel, unfortunately: it’s a difficult one to answer. People are understandably protective of their local hospitals; after all, they pay a hell of a lot of money for them. But when groups, academics, clinicians or whoever else suggest ways to reform the NHS, it’s important that sentimentality or scare-mongering do not cloud the debate. Our system is far from perfect and it can be drastically improved. Most people would agree with that.

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