NHS Reform

Health Secretary Lansley has been all over the media like a very unpleasant rash recently. He had a nightly slot on the PM programme, along with turns on just about every news media show. In these propaganda slots he kept citing ‘evidence’ as the driving force behind his non-manifesto’d NHS reforms.

Ben Goldacre writing in the Guardian cited several sources in a recent article challenging this ‘evidence.’ 

“There have been 15 major reorganisations of the NHS in 30 years. We've had GP fundholders, GP multifunds, primary care groups, PCTs, family practitioner committees, purchasing consortiums, and more. After all this change, lots of data should have been gathered on the impact of specific strategies.

In reality, few were properly studied. Here are four papers on GP fundholding, which is broadly similar to Lansley's GP consortiums. Kay in 2002 found it was introduced and then abolished without any evidence of its effects. In 2006 Greener and Mannion found a mix of good and bad, but no evidence that it improved patient care. In 1995, Coulter found nothing but gaps in the evidence and no sign of any improvement in efficiency, responsiveness or quality. Petchley found there was insufficient data to make any judgment. Lansley says he is following the evidence. I see no evidence to follow here.

Next, competition. Lansley has repeatedly denied that he is introducing competition on price. This is disturbing behaviour: his bill explicitly introduces price-based competition, it's in paragraph 5:43 of his NHS Operating Framework.” my emphases

There is also this little nugget from Private Eye (4/2/11). 

“ Since May 2010 the Department of Health has been advised on “commissioning”, which will be handed to consortia of GPs who will be required to operate competitively, by management consultants McKinsey (paid £6.5 m) and KPMG (earner of £1.2m between May and November). As luck would have it, KPMG have already won a commissioning contract in London under the new arrangements. 

McKinsey’s last big public-service reorganisation was the break up of HM Revenue and Customs (HMRC) into incomprehensible business units when the Inland Revenue and Customs merged six years ago. Two weeks ago, poring over the department’s lamentable record ever since, MP Andrew Tyrie, chair of the Commons Treasury select committee asked senior HMRC staff representatives if the reorganisation was indeed “on the basis of a plan by McKinsey....that turned out to be a disaster, is that right?” “Yes,” came the unequivocal response.

KPMG meanwhile, advised the government on another disastrous break-up around the same time: the sale of international development fund CDC’s fund-management arm Actis, labelled “shameful” by secretary of state Andrew Mitchell.”  

Lansley is as slippery as a piece of soap on a very slippery slide. He cannot be trusted. Neither can his so-called consultants.

As Ben Goldacre concludes, “when Lansley says all the evidence supports his interventions, as he has done repeatedly, he is simply wrong. His wrongness is not a matter of opinion, it is a fact, and his pretence at data-driven neutrality is not just irritating, it's also hard to admire. There's no need to hide behind a cloak of scientific authority, murmuring the word "evidence" into microphones. If your reforms are a matter of ideology, legacy, whim and faith, then, like many of your predecessors, you could simply say so, and leave "evidence" to people who mean it.” Guardian online 5/2/2011