King's Fund marks down Coalition's NHS scorecard
The NHS remained in the headlines this week as a result of the latest publication from the King’s Fund, ‘The NHS under the Coalition Government’. After reading all 84 pages, Ben Gowland is left with more questions than answers.
The media latched on to ‘The NHS under the Coalition Government’ with enthusiasm because it is critical both of the coalition government for wasting NHS energy and effort in a wholesale reorganisation for the first 3 years of its term - having explicitly promised not to do so before the election - and of the opposition, for overplaying the impact of the Act on the privatisation of services in the NHS.
But having worked through this weighty 84 pages of the document, it is hard to know exactly what it is trying to do or say. It says that it is, ‘an initial attempt to shed light on health and social care reforms… (because) in the forthcoming election, independent analysis based on available evidence and informal interpretation is particularly important’ (p7).
Unfortunately it doesn’t go on to say whom this analysis is important for: is it for the electorate to inform their voting decisions? Is it for the politicians so that they can learn from their mistakes? Is it for the service to take stock of where we are now? Or is it to try and help the country just understand exactly what has happened over the last 5 years?
Maybe all of the above. It has come out three months before the election, and as a result has certainly piqued the interest of the media. I can’t help but feel a sense of missed opportunity. The King’s Fund could have used the content and timing to get some really important messages across.
It seems to me that the real value of reflection lies in the lessons for the future, and in the face of such a difficult time for the NHS we desperately need some clear sensible messages, so that any changes that are made after the election help rather than hinder.
To be fair, the report does draw some learning points (I am not sure they are presented as strongly as conclusions), which are tucked away in the middle of the report on pages 26 and 27.
The main message is that, if nothing else, the last five years have demonstrated the dangers of a top down reorganisation, and there is a plea for the incoming government not to repeat the mistake. But we were saying that 5 years ago, so it is hardly a revelatory insight!
So what would we have wanted the report to say? What are the big lessons from the last 5 years? And what are the issues that need to be addressed? I would suggest there are at least four.
First, we have seen that a combination of the space between the service and government provided by the Health and Social Care Act, and the lack of trust in all political parties to take care of the NHS, means that there is a huge opportunity for the NHS to start to become master of its own destiny.
The 5 Year Forward View has beautifully demonstrated this. The politicians might not be able to articulate a coherent vision for the future of the NHS, but the service can. What the NHS must do now is build on that and not cede power back to the politicians post-election.
Second, the divisive fragmentation in regulation has to be addressed. The current fiasco with regards to the 2015/16 tariff seems at its heart to be a power play between regulators, exemplified by the TDA response to the consultation.
This split is not serving the NHS well, and is adding no benefit. If the NHS is to have a strong voice, national public infighting has to end, and the integration sought at local level needs to be exemplified by NHS England, Monitor and the TDA.
Third, health and social care have to be brought together. Even if this is a purely defensive decision designed to prevent the cuts to adult social care bringing the NHS to its knees, it has to happen. Everyone experiencing the pain of this winter is clear that the separation of the two cannot go on.
Fourth, if we have moved to a focus on integration supported by regulation, then the role of commissioning needs to change from one focussed on contracting and procurement, to one that explicitly supports and enables system change. This clearly needs unpacking, and so I’ll come back to this in a future article.
History is important because understanding and learning from the past enables us to make better choices about the future. If the King’s Fund report tells us nothing else it reminds us that there are huge lessons to be learnt from the last 5 years, and that we must not reset the clock on the 7th May.
The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of The Information Daily, its parent company or any associated businesses.
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