Friday, April 16, 2021
HomeCOVID-19How chaotic reforms crippled the NHS’s virus response

How chaotic reforms crippled the NHS’s virus response

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WITH tiers, flip-flops and contradictory pronouncements, the Government appears to have turned our attention away from the real problem, which is NHS reforms.

Increasingly, every winter the NHS goes into deeper and deeper crisis. The Covid pandemic is merely one factor in this crisis.  

There are several reasons, but the main one is that of recent governments: They have lost the ability to make major legislation as the EU has relieved them of much of that responsibility. When they do try, they make a complete mess of it, Brexit being just one example.

Looking back a few years at the NHS, we first had the ill thought-out Kenneth Clarke reforms of 1989 and 1990, introducing an internal market.  

For those interested, it is worth looking at the East Anglian Regional Health Authority’s so-called ‘Rubber Windmill’ simulation of the NHS internal market in 1990. https://www.kingsfund.org.uk/publications/articles/return-windmill-behavioural-modelling-and-future 

As the exercise progressed, the simulated system collapsed under the weight of conflicting financial and competitive pressures, highlighting what would become an increasing problem – the lack of effective management of any internal market.

The next attempt at sorting things out was Health Secretary Andrew Lansley’s reforms (2012 Health and Social Care Act) of 2015. https://www.kingsfund.org.uk/blog/2015/02/government-record-nhs-reform-our-verdict That was the year health visitors moved into local government to complete the transfer of public health from the NHS to councils.  

This wrapped up a reform programme described by former NHS chief executive Sir David Nicholson as ‘so big it could be seen from space’.  

In reality, the NHS was still struggling with running a failing service along with coping with the Clarke reforms. Just what it didn’t need was another radical, ill thought-out reorganisation with all sorts of unforeseen consequences.

Yes, ‘we’ created NHS England to run the NHS, with new regulators and GP-led clinical commissioning groups (CCGs) replacing primary care trusts and town halls driving ‘healthy lifestyle’ programmes.  

Did we really think that greater competition in the NHS would improve it? Obviously not, because in 2019 the NHS Long Term Plan stated that collaboration was the key. The key to what, though?

Along with the reforms, NHS trusts were having to fund onerous Private Finance Initiative building programmes, whereby they were saddled with excessive debts for 25-year periods just so governments could keep the programmes off their debt balance sheet, but at enormous cost.  

All the trusts could do to try to balance the books was cut back on everything else. I’m sure I’m not alone,  when visiting beautiful new state-of-the art hospitals, in seeing wards closed and front-line staff increasingly demoralised as the few are overwhelmed by the work at hand. Both staff and patients suffer as a result.

So here we had an NHS all set for a crisis. Yes, the number of people infected with Covid or needing hospital treatment is not large compared with the normal NHS intake, but that number has been enough to threaten total collapse.  

That is what really frightens the Government. It doesn’t want an underfunded NHS that has suffered various disastrous reforms under Conservative administrations to fail on its watch.  

This winter was going to be bad for the NHS, with its huge shortages of nurses and doctors (thank you, Jeremy Hunt) even without Covid. But with it, the Government’s arrogant incompetence has been shown up for what it is.

Would a Corbyn administration have fared better? That seems highly unlikely to me.
 

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Greg Browne
Greg Browne had a career in the military, including research and analysis, followed by a small business in IT installation and support. He is now enjoying retirement.

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