Coalition’s NHS vision: diluting standards and incentivising profit

Six and a half years is a long time in politics, by any standards. But was it long enough for Andrew Lansley, as shadow health secretary, to master his brief and work out clear, readied plans for government. Serious doubts are now being raised about the coherence of Tory health plans (with little evidence of Lib Dem impact on the Coalition agenda).

Reassuring pre-election pledges about real-terms budget increases and service centralisation (requiring full local patient and GP agreement) were made by David Cameron. Yet behind these lay further rhetoric against targets and minimum standards, and promises to increase competition and private providers in NHS service provision.

Whereas other controversial commitments were dropped under the Coalition agreement, Health Secretary Lansley is pushing ahead with dilution of NHS universal standards and promoting risky plans giving GPs total budget control to buy all NHS care. An NHS-wide Department of Health edict this week abolishes targets for minimum waiting times for inpatient surgery and to see a GP, plus almost halves the NHS management cost.

There was a further question mark about the “no service centralisation”. The Guardian has reported a detailed FOI study of aortic aneurism surgery outcomes,  which confirmed that death rates decrease when complex procedures are done in specialist units.

Meanwhile, there is growing concern about the policy to give NHS budgets direct to GPs – previously highlighted by LFF as “counter-cultural”.

The head of the Kings Fund health think-tank, Professor Chris Ham, recently underlined the risks of GP budget-holding, based on US experience.

Ham recommended “caution in promoting budget holding as a universal solution”, with a key concern over incentives for profit: “that [financial] surpluses may result from skimping care”. The US experience saw “a national popular backlash against capitation [budgets] from patients and physicians”. Ham however, has also recently set out the context for Lansley’s NHS inheritance: “New Labour inherited the NHS in intensive care, by 2010 it was in active rehabilitation. The issue for the coalition government is how to get it into rude health”.

The Health Services Journal, normally cheerleader for radical NHS change, suggests in a highly critical editorial that Lansley risks a collision course with the PM and Chancellor over his budget-devolution plans, given GP’s lack of enthusiasm to take them on.

Meanwhile, despite its supposed protected status, the NHS is planning for a £15-20 billion of efficiency savings by 2014. Giving NHS budgets to GPs and curbing to service changes driven by improved outcomes are likely to bring headlines for the Coalition about service cut backs and budget overspends later this year.