UK: Health Care Policy Mayhem…and a Very Public Scandal

Robert Royce
Those seeking some clarity regarding the future of health care policy in the UK will be forgiven for being baffled by recent events. First up was an abortive attempt by the government to introduce a requirement for National Health Service commissioners (known as clinical commissioning groups –see my article on “Health Care Reform in England” in the August, 2012 issue of Managed Care to undertake formal market testing of services. This may not seem unduly controversial – indeed in many countries it’s a legal requirement, especially as these can be multi-million dollar contracts  – but the announcement was greeted by uproar from a wide variety of groups  – including doctors  – as heralding the privatization of the NHS.

A rapid U-turn followed, perhaps revealing the fragile nature of the current Conservative/Liberal Democrat coalition and its lack of conviction on the matter of ensuring that more competition is introduced into the NHS. The offending paragraphs have been rewritten but the issue will continue to bubble along, not least because there is a view that anything other than formal competitive tendering will eventually be deemed illegal.

There was further disappointment for those hoping for more private sector involvement in the running of NHS hospitals with the result of a review of three hospitals that made up an organization known as South London NHS Trust (SLHT). When it was declared no longer financially viable (it had been running massive deficits), there was some expectation that one or more of the hospitals would be run/taken over by a private health care company. Despite some expressions of interest by the private sector, it was recommended that the three hospitals be acquired by neighbouring NHS organizations. One reason given for that decision was that an open procurement process would take too long.

As a further illustration of how far this process departed from a “normal” insolvency regime, you have a key recommendation to downgrade the services of a neighbouring hospital to the three that formed SLHT. This action is akin to a bankruptcy of a firm where the administrators solve that firm’s problem by deciding to shut down a rival enterprise. Unsurprisingly, this is now subject to a legal challenge —which will delay implementation of all the proposals, thus undermining the reason given for not going to a procurement process to see who should run these hospitals!

All of this has taken place against a backdrop of unparalleled criticism of the managerial culture of the NHS and the quality of care being delivered. The catalyst for this has been a long-awaited report of a public inquiry into poor care delivered by Mid Staffordshire NHS trust. The Francis Report, after the judge, Robert Francis who conducted the inquiry, has severely criticized the way the two hospitals were run and the wider managerial culture of an NHS seen as obsessed with hitting financial and performance targets at the expense of individual patient care. There have been widespread public and media demands for the head of the NHS in England, Sir David Nicholson, to resign, and considerable dismay about a perceived wider lack of accountability for what went on.

A recent survey of chairmen of NHS Trusts in England has revealed that 74 percent think there are other hospitals with similar problems to Mid Staffs. Given the catalogue of neglect documented in the Francis Report, one hopes they are wrong. It is very likely that the next few years will bring a whole raft of failing NHS hospitals into the headlights. What to do about them remains less than clear….

Robert Royce, PhD, is an independent health care consultant and writer in the United Kingdom. Twitter:DRROBERTROYCE

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