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Friday 30 September 2016
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Lansley making same old NHS reorganisation mistakes, warns expert

The government's radical reorganisation of the NHS in England is likely to cost between £2bn and £3bn to implement, with no guarantee that it will improve performance or lead to better care for patients, an expert has warned.

In a bmj.com article, Kieran Walshe, Professor of Health Policy and Management at Manchester Business School, says there is very little evidence that past NHS reorganisations have produced much, or any, improvement, and argues that the new government "looks likely to make all these mistakes again."

He says that Andrew Lansley "seems to have learned little from the past history of NHS reorganisation", pointing to a recent National Audit Office study of more than 90 government reorganisations, which found that, despite huge costs, the benefits were unclear, the process was often poorly managed, and that the impact on performance was often adverse.

"Structural reorganisations don't work," says Professor Walshe, arguing that there is little evidence to suggest that any of the different commissioning structures put in place over the last 20 years were "better or worse than others or that the proposed changes will work any better than the current arrangements."

Indeed, some would argue that the perceived failures of healthcare commissioning result not from any particular structure but from these repeated reorganisations and the discontinuity and disruption they produce, he adds.

Professor Walshe also says that the transitional costs of large-scale NHS reorganisations are huge, and "the intended or projected savings from abolishing or downsizing organisations are rarely realised".

He estimates that the proposed NHS reorganisation will cost between £2bn and £3bn to implement, "at a time of unprecedented financial austerity", and questions whether these changes will produce higher or lower management costs.

Finally, he warns that reorganisation adversely affects service performance, is "a huge distraction from the real mission of the NHS – delivering healthcare and improving healthcare quality – and can absorb a massive amount of managerial and clinical time and effort".

The government should produce empirical evidence, not ideological platitudes, to justify the case for change, concludes Professor Walshe.

He writes: "The intended costs and benefits must be made explicit and measurable … and a systematic analysis of the impact of the reorganisation should be produced within two years of its implementation and presented to parliament."

BMJ

Your comments (terms and conditions apply):

"Micro-management and layers of bureaucracy have cost the health service a lot of money and policies that pit secondary care and primary care against each other are expensive as well as divisive and demoralising. I believe that complete redesign from the bottom up is the right direction but there must be enough resources to build strong infrastructures to support all GPs, including those who are unwilling to become actively involved in the commissioning process. Trust at last is being returned to the professionals, so I agree that we should rise to the challenge and seize the opportunities with enthusiasm" – Kate Harlow, Tunbridge Wells

"I understand why many people think GP consortia will be more cost-effective than PCTs. But – if consortia have all the responsibilities of PCTs dumped on them, they will need to develop all the same bureaucracy and "management costs". Hopefully the government will realise this and really cut back on the red tape" – Name and address withheld

"Commissioning is largely procurement and procurement is a profession. Those who do it must be professionally trained and developed. GPs are professional doctors, not professional buyers, accountants, lawyers etc. Also, increasing the number of buyers fragments the procurement leverage which will lead to higher costs, both from the deals and from the process costs of developing and managing the contracts. This will cost more not less in addition to the costs of reorganising as identified by Prof Walshe. This relates to political ideology and career building, not pragmatic improvement for patients and taxpayers" – Name and address withheld

"It would be a luxury to have some organisational stability in the NHS but these changes, whilst radical and likely to produce some drastic cuts, at least put the money in the hands of those spending it. The 'no bail-out' conditions will mean some GP practices go to the wall. It may well allow the private sector the way in that they have been looking for, so come on primary care, wake up to the opportunities as well as the risks this time and deliver the goods!" – Name and address withheld

"I think it is impossible to say but I am sure that cutting down on red tape and allowing those who are involved in clinical  medicine to have more say re how system works can only be good. It should predominantly be GPs and community-based practitioners rather than hospital consultants who have no knowledge of business while GPs have practice managers behind them" – Name and address withheld