Peter Reynolds

I have grave concerns about the government’s NHS reforms.  I feel like it’s Groundhog  Day.

I was deeply involved in the last major health service reforms back in the 1990s.  I am hearing exactly the same ideas, phrases and promises as we heard then.  Haven’t we done this all before?

When the “internal market” was introduced and the first NHS Trusts were “founded”, the idea of  marketing was introduced to the NHS for the first time.  I saw the opportunity, organised a conference at the QEII conference centre and built a nice business, thank you very much, for several years as an expert in the field.    I was an advisor to several health authorities and a number of the new NHS trusts.  I undertook marketing and communications audits, ran training courses and I made something of a specialty of designing, writing and producing annual reports.   I learned a lot and I felt I contributed a lot.  Why is it all being done again?

Marketing is a perfect description of the way the health service should work.  It is the management process responsible for anticipating, identifying and satisfying customer needs efficiently.  The 1990s NHS model was that  “purchasers”, health authorities and GP fundholders, would buy services from “providers”, hospitals and community health services.  “Purchasing” was later renamed “commissioning” to reflect how complex the task is. It’s about understanding what services are required and making complex choices as well as actually contracting for them.

Strategic Health Authorities (SHAs) were always a redundant tier of bureaucracy in my view.  District Health Authorities (DHAs) were to be the principal commissioners but the plan was that GP fundholders would eventually take over most of it with DHAs becoming centres of expertise rather than administration.  Then there was a rather messy fudge between GPs and community health services and we ended up with Primary Care Trusts (PCTs).

There is a huge amount of expertise required in commissioning.  The complexity of the tasks involved – understanding, assessing, testing, planning, choosing, contracting and much more, is enormous.  GPs will have to buy in that expertise which will build a bureaucracy which we will call – what?  We will have gone round in a circle.

One of the biggest mistakes made about the NHS is the endless stream of attacks on managers.  Almost all the problems that the NHS has and that people complain about are management problems.  NHS managers have a hugely demanding and thankless task for which they are regularly pilloried and censured.  They are, actually, crucial to an effective NHS, just as much as the clinicians.

So now we are to have “Foundation Trusts” and GP commissioning.  It is the same thing, yet again, under a slightly different name.  The NHS is not broken. It is, in fact, greatly improved.  It doesn’t need fixing.

We do not need more reform.  We need some adjustments.  There have been great achievements on waiting times.   Now, we need to shift the emphasis towards outcomes.  We need targets on quality rather than quantity.  It’s a tweak rather than a revolution.