Radical Reform of the National Health Service in the UK in 2011: Background, Proposals, Prospects,...

Radical Reform of the National Health Service in the UK in 2011: Background, Proposals, Prospects,

and Lessons for Russia

National Research University Higher School of Economics

Masters in Management and Economics of Health Services

Seminar Presentation 21 March 2011

Dr. Christopher DavisDepartment of Economics and School of Interdisciplinary Area Studies

University of Oxford

Motivations for Medical System Reform• Control rising cost of medical care, reflected in

increasing health shares of GDP, driven by ageing populations and technological progress

• Improvement in access to medical care and reductions in health inequalities

• Improvement of quality of medical care• Reductions in inefficiencies, duplication in the medical

system• Improvements in health outcomes (survival rates, raising

life expectancy)• Reducing public dissatisfaction with medical care and

increasing patients’ choice of treatment

Health Reform Waves: 1990-2000s[Toth (2010) review of reforms in France, Germany, Netherlands, New Zealand, Sweden and UK]

• Early 1990s: Introduce market-style mechanisms, greater competition, purchaser-provider split, patients’ choice.

• Mid 1990s: Criticism of market mechanisms, unclear impact on efficiency but worse equity and access. Emphasis on improving integration of components of medical system. UK abolishes fund-holding and adopts Primary Care Trusts.

• 2000s: Emphasis on quality of care and patients’ rights. Patients in NHS can choose provider and funds follow.

Unexpected Health Reforms During Global Financial Economic Crisis

• Russia 2008: “Priority Health Project” and “Conception of Health RF to 2020”

• China 2009: “Implementation Plan for the Recent Priorities of the Health Care System Reform (2009-2011)”.

• USA 2010: Senate Bill 3590 “Patient Protection and Affordable Care Act”

• UK 2011: “Health and Social Care Bill”4

Questions to be Answered

• What are the main problems in the UK health system?

• Have past health reforms worked?• What are the features of the announced

2010-11 UK health reforms?• What are the criticisms of the new

health reforms and the prospects for their adoption ?

Structure of Presentation• Concepts used in Analysis of Health Reforms– Health in Political and Economic Systems– Governance in Health Systems– Health Production and Health Outcomes– Priority of the Health Sector and Health Financing– Measurement of Health System Coverage of Population,

Benefits and Cost-Sharing

• Sources of Data• Principles and Development of the UK NHS• Health Reforms in UK and Russia 1990-2010• 2010-11 Proposals for Radical Reform of the UK

NHS and Criticisms of Them

Political System, State Priorities and Health• Importance of politics in health reform– Sheiman & Shishkin 2009: “After an unsuccessful start of the

programme of monetization of benefits in early 2005 discussion of health reform legislation was minimized ..Transformations in organization, management and financing of the health service were moved to the back burner.”

• Political system – influences health sector (State bureaucracy, political

parties, legislature, interest groups, voters, public opinion and expressions of discontent)

• State priorities – influence allocations of resources, protection of

health sector in a crisis, and degree of inequalities

Political Actors Influencing Health ReformExecutive Government Legislature Political Opposition Non-Governmental (UK Shadow Government)

Opposition Party Leader

Party Leader

Leader (Prime, Minister,

President

Cabinet, Council of Ministers

Ministries (including Health)

Defence Health Education

Professional Groups

Think Tanks

Media

NGOs

Public

Cabinet


Parliament, Duma

Regions

Districts

Medical Units

Committees, Commissions

(including Health)

Davis 2011

Governance in Health Services• Health systems made up of many institutions

(central and regional government, regulators, boards, medical facilities) that need to achieve objectives while maintaining standards and controlling costs.

• To achieve this requires good governance (Strategy, Leadership, Vision, Assurance, Probity) [2011 Governing the New NHS]

• Governance different from, but related to, operational management

• Many UK NHS reforms aimed at improving health governance

Public Concern about Health in Russia, China, USA

RUSSIA USA CHINA

USA

CHINA

RUSSIA

10

Health Sector in an Economic System

Economic Policies Fiscal, Monetary, Industrial, Foreign Trade, Exchange Rate

Economic Environment Natural Resources, Population, Integrity of Economic Space,

External Economic Factors,

Economic System

Health Sector Household

Medical System Medical Supply Medical Industry

Biomedical R & D Medical Foreign Trade

Health Bureaucracy

Performance of Health Institutions Quantity of Medical Services Quality of Medical Services Medical System Efficiency

Sufficiency of Medical Inputs Effectiveness of Supply System

Production of Medicines and Medical Equipment

Medical Technology Innovation Imports of Medicines and

Medical Equipment

Health Sector Production Process

Preventive Services Curative Services

Medical Foreign Trade

Central Health Bureaucracy

Biomedical R & D

Medical Industry

Medical System

Medical Supply System

Allocation of Resources

1 2 3 4 5 6

1

2

Household Health Production

Consumption

Environment

Demography

Illness Pattern

Medical Treatment

Health Output (Mortality, Invalidity)

12

Impacts of Reforms on Health System Coverage of Population, Benefits and Cost-Sharing

WHO 2008, Fig. 2.2

Sources of Data for Presentation• Data for Empirical Assessments– Official Russian sources– OECD databank and reports

• Data for Diagram of Health Coverage, Benefits and Cost-Sharing

• Information about Current UK Health Reforms– Official documents (White Paper and Parliament Bill)– Think Tanks (Kings Fund, Nuffield Foundation)– Academic Journals– Newspapers

Empirical Estimation of Trends in Axis Variables in Health Diagram

• X Axis: Coverage of Population (% of population covered by a national health service (NHS) or health insurance (100% public, mixed public-private, or subsidized private)). Government statistics and reports. Reliable estimation of trends.

• Y Axis: Coverage of Benefits (% of potential benefits in a country provided to the population). Measurement more problematic . Identify maximum standard in a country and evaluate how provision of the average citizen deviated.

• Z Axis: Coverage of Costs (% of health costs covered by public sources). Estimates of this indicator based on government statistics and independent reports. Measurement reliable.

15

Establishment of UK NHS in 1948• First national health service in democratic system not

based on insurance. Established in July 1948 with principles– Universal coverage– Free of direct charge– General taxation source of finance for NHS– Pooling of financial risk at centre – Collective provision– Promotion of advances in medical science

• Political struggle over the reform– Government and medical professional in favour of reform– Opposition by Interest groups (hospital doctors, GPs, other

medical workers, trade unions, patients, NGOs)– Local government opposed to centralisation– Groups fights to maintain “freedom of choice” (patients have

right to choose doctors, doctors have right to choose treatments)

Compromises and Actual Arrangements in Establishing the UK NHS

• More a national hospital service than a national health service

• Compromises– Teaching hospitals subordinate to centre whereas other

hospitals under local government– Doctors (but not other medical professionals) have key

management roles– Local government keeps control of district nurses, child

welfare, public health– GPs not salaried or employed by government. Sign

contracts with Executive Committee run by GPs. Paid on capitation basis (related to patient list)

– Groups of GPs encouraged but not mandatory– Private practice by hospital doctors allowed

Structure of UK NHS in 1948

NHS Developments and Reforms 1948 – 1980s

• Substantial growth of NHS and quantities of services provided

• Significant increase in medical technology in NHS and in quality of care

• Continuing increase in the cost of the NHS (HE % GDP rises from 3.5 % to 5.6 %)

• Improvements in almost all measures of health outcomes (e.g. life expectancy)

• But shortages, queuing, rationing• Reforms introduced to improve performance

– 1950 – 73 Technocratic change (planning, management)– 1974 Unification/integration, Regional Health Authorities,

Community Care Councils– 1982 Introduce general management, outsourcing (contracting

out to private sector of non-essential services)

UK Elections, Parties in Power and Health Reforms: 1945-1989

Election Party in Power Major Health Reforms

1945, 1950 Labour 1945-19511948 Establishment of NHS, technocratic changes to improve planning and management

1951, 1955, 1959 Conservative 1951-1964More technocratic reforms, greater attempts to reduce regional inequalities through planning and re-distribution

1964, 1966 Labour 1964-1970More technocratic reforms, greater attempts to reduce regional inequalities through planning and re-distribution

1970 Conservative 1970-1974More technocratic reforms, greater attempts to reduce regional inequalities through planning and re-distribution

1974 Labour 1974-1979

1974 focus on unification and integration. Establishment of Regional Health Authorities (15), Area HA (90), and 200 District Mangement Teams and Community Health Councils (voice of consumers). 1976 Resource Allocation Working Party (RAWP) to re-distribute funds across regions.

1979, 1983 Conservative 1979-1987

1979 Royal Commission on NHS criticises 1974 reforms for increasing bureaucracy. 1982 reform promotes simplification and decentralisation. Elimination of Area Health Authorities. Family Practitioner Councils become independent. Encourages local fund-raising and private sector involvement.

C. Davis 2011

Structure of UK NHS: 1974 and 1982

Comparison of the UK and USSR NHS in the 1980sUK USSR

Emphasis on individual rights Emphasis on the collective and the stateMultiple political parties Single Communist PartyContested elections Uncontested electionsFree press Censored press Firm party discipline Rigid party disciplineStrong popular support for the NHS Strong popular support for the NHSPopular dissatisfaction with performance of NHS an important political issue

Popular dissatisfaction with performance of NHS an insignificant political issue

UK USSRMost property in private sector Most property in state sectorMarket regulation of the economy Central plan regulation of the economyConsumers have strong market power relative to suppliers (buyers' market)

Consumers have weak market power relative to suppliers (sellers' market)

Weak government control of income and consumption Strong government control of income and consumptionEconomy open to world competition (private control of foreign trade)

Economy closed to world competition (state monopoly of foreign trade)

High consumption share of national income Low consumption share of national income Chronic excess supply in consumption markets Chronic excess demand in consumption marketsUnequal distribution of income and wealth Unequal distribution of income and privileges

State-owned NHS an anomaly in market economy State-owned NHS typical component of centrally planned economy

Political system

Economic system

Davis 1990

Performance of the UK and USSR NHS[Davis 1990 chapter in Social Policy Review]• Rising demand for medical care• Successful cost containment in both countries

[1984 The Painful Prescription]• Shortages in both health services, but more acute

in USSR• Pervasive rationing of medical care in both health

services• UK lags behind most EC countries in availability of

medical technology (71 % average MRI), but is substantially more advanced than USSR

• Almost all health outcome indicators better in UK than in USSR

Russia Health System Coverage of Population, Benefits and Costs in 1990

Total Health Expenditure

Depth: % of Benefits Covered by

Public

Width: % of Population Covered

0

100

100

100

Russia Health 1990

Universal Coverage in 1990

State Guarantee

Height: % of Costs Covered by

Public

80.0 %

80.0 %

Davis 2010 (Concept from WHO 2008, Fig. 2.2)

Male Life Expectancy 1980-2008: UK, USA, China, Russia

50.0

55.0

60.0

65.0

70.0

75.0

80.019

80

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

Year

s

USA

China

Russia

UK

Objectives of Health Reforms in UK

• Control cost of medical care• Improve efficiency so that health spending has

greater impact• Reduce bureaucracy, strengthen purchaser-

provider split, increase competition• Devolve decision making and resource

allocation to consortia of GPs• Give patients greater choice of treatment

paths

Health Reforms in the UK in the 1990s

• 1990 NHS and Community Care Act of Conservative government

• 1991 Introduction of the “internal market”. Purchaser-provider split. Two models of purchasing: health authorities and GP fundholders (non-urgent elective and community care for patients).

• 1994 Total Purchasing Pilot Scheme allows GPs to commission all services

• 1997 GP fundholders abolished in favour of Primary Care Groups and Trusts (PCG, PCT) that maintain Purchaser-Provider split

UK Elections, Parties in Power and Health Reforms: 1990-2010

Election Party in Power Major Health Reforms

1987, 1992 Conservative 1987-1997

1990 NHS and Community Care Act introduces "internal market" and general management, creates Hospital Trusts ("sellers"), health authorities become "commissioners" (buyers). 1992 Private Finance Initiative for mixed funding of NHS facilities. 1997 White Paper The New NHS. Modern, Dependable establishes Primary Care Trusts (PCTs).

1997, 2001, 2005 Labour 1997-2010

1997 Devolution of UK NHS to England, Scotland, Wales, Northern Ireland. 2000 The NHS Plan creates Care Trusts. 2001 Creat National Patient Safety Agency. 2002 Create Strategic Health Authorities. 2004 Create Create Commission for Healthcare Audit and Inspection (CHAI). 2005 Create National Institute for Health and Clinical Excellence (NICE) from old NICE. 2006 Commissioning a Patient-Led NHS establishes GP Practice-Based Commissioning.

Source: C. Davis 2011

Evolution of Purchaser-Provider Relationships in UK NHS

Purchaser-Provider Arrangements in the UK NHS in the 1990s

Health Reforms in Russia 1990-2008

• 1991-1993 Introduction of CMI and other health reforms• Deterioration of economic performance, weak state, over-

ambition means most health reforms fail in 1990s• In 2000s more emphasis on health education, prevention• Intensified reforms related to management and incentives

in the medical system• Improvements of CMI system• Adoption of Federal Goal Programs in health for 2002-06

to supplement normal activities• Priority National Project in Health 2006-10• Adoption in December 2008 of Conception of Health RF

to 2020• Real health expenditures from state budget, CMI and

private sector increase substantially

Medical Systems in China, USA, Russia, UKIndicators Units 2000 2007

Doctors Per 1,000 population 1.7 1.5Hospital Beds Per 1,000 population 2.4 2.7Middle Medical per doctor Number 2.8 3.1




China

USA

Russia

UK

Russia Health System Coverage of Population, Benefits and Costs in 1990, 2007



Public


0

100

100

100

Russia Health 1990

Universal Coverage in 1990, 2007

Russia Health 2007

State Guarantee


Public

65.0 %

80.0 %

60.0 %

80.0 %


Male Life Expectancy 1980-2008: UK, USA, China, Russia

50.0

55.0

60.0

65.0

70.0

75.0

80.019

80

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

Year

s

USA

China

Russia

UK

1381990 20001995

142

146

150

2005 2010

ИЗМЕНЕНИЕ ЧИСЛЕННОСТИ НАСЕЛЕНИЯ

МЛН. ЧЕЛОВЕК

2015 2020

Цель145 млн

Россия

142 млн

641980 1995 20001985 1990

68

72

76

80

2005 2010

ДИНАМИКА ОЖИДАЕМОЙ ПРОДОЛЖИТЕЛЬНОСТИ ЖИЗНИ В РОССИИ И В СТРАНАХ ЕВРОСОЮЗА

«Старые» страны ЕСВОЗРАСТ

2015 2020

75 лет

67,5 лет

Цель

«Новые» страны ЕС

Россия

91980 1995 20001985 1990

11

13

15

17

2005 2010

СМЕРТНОСТЬ НАСЕЛЕНИЯ РФ

«Старые» страны ЕС

ОБ

ЩИ

Й К

ОЭ

ФФ

ИЦ

ИЕ

НТ

СМ

ЕР

ТН

ОС

ТИ

НА

1 Т

ЫС

. Ч

ЕЛ

ОВ

ЕК

2015 2020

10«Новые» страны ЕС

Россия

Population: 142 millionArea: 17 million км2 Birth Rate: 11.3 per 1,000Crude Death Rate: 14.6 per 1,000

1

ДЕМОГРАФИЧЕСКАЯ ПОЛИТИКА ВРОССИЙСКОЙ ФЕДЕРАЦИИ

Russia Health System Coverage of Population, Benefits and Costs in 2007, 2020



Public


0

100

100

100

Russia Health 2020


Russia Health 2007

State Guarantee


Public

65.0 %

60.0 %

60.0 %

70.0 %


Developments of Health in the UKin the 2000s

• In 2002 Phasing out of Health Authorities, move to 152 PCTs with ave pop of 300,000 and responsibility for £ 80 b (80% NHS)

• 2004 new form of commissioning Practice-Based Commissioning (PBC): GP practices given indicative budget by PCT and encouraged to make savings while achieving quality targets

• 2007 World Class Commissioning. Set standards for PCTs and PBCs

UK NHS Structure Late 2000s

2010 UK NHS Governance

Patient Contacts in NHS

NHS Expenditure Early 2000s

Primary Care Trusts• 300 (reduced to 150) Primary Care Trusts are subordinate to

the Strategic Health Authority and represent the local Primary Care community (GPs, dentists, public health).

• Objectives are to improve the health of the community, engage in partnership work and community-based health and care initiatives, implement population screening programmes, develop and integrate family health services, medical (primary care), dental and optical

• Have assumed responsibility from district health authorities of commissioning (purchasing) of community, secondary care and tertiary/specialised services

• Also responsible for mental health, emergency ambulance and patient transport services, NHS Direct and walk-in centres

NHS Trusts and Foundation Trusts• NHS Hospital Trusts– Hospital trusts subordinate to Strategic Health Authorities

and need to satisfy annual accountability agreements– More freedom of activities than previously– Provide services to PCTs– Must satisfy standards set by Care Quality Commission

• Foundation Trusts– NHS Trusts that are promoted by Monitor because they

satisfy stringent criteria concerning financial viability– Greater autonomy in medical and financial activities– Provide medical services to PCTs in accordance with

contracts– Must satisfy Monitor and Care Quality Commission

Foundation Trusts

Monitor• Monitory established in 2004. Executive non-

departmental public body• Oversees performance of NHS Trusts (primarily on

financial grounds) and grants selected ones licences to operate as Foundation Trusts.

• Has sole responsibility for overseeing Foundation Trusts to ensure their financial viability while maintaining agreed safety and medical quality standards

• Assigns each FT risk ratings on an annual basis, which influences detail of supervision

• Can intervene to direct activities of failing FTs

NICE• In 1999 National Institute for Clinical Excellence

established to provide information to patients, the public and medical professionals on evidence-based practice in the prevention and treatment of illness. Carried out cost-effectiveness studies of diagnostics, medicines, medical devices, clinical management of illnesses, and public health interventions.

• In 2005 old NICE merged with Health Development Agency to form the National Institute for Health and Clinical Excellence, but has kept the acronym NICE.

• Produces clinical guidelines concerning treatment, appraisal guidance on drugs and techniques, and guidance on safety and efficacy of curative and preventive interventions.

• Developing 150 new standards of treatment for specific diseases that will be used in National Service Frameworks

Care Quality Commission (CQC)

• In 2009 CQC established as new “super-regulator” to supervise and inspect the quality of all providers of secondary/tertiary medical care and social care

• Ensures that all organisations adhere to detailed Essential Standards.

• Promotes achievement of outcome measures.• Rates the performance of NHS Hospital Trusts

UK Total Health Expenditure as % of GDP: 1980 - 2008

Health Expenditure Shares of GDP in International Perspective

RussiaUK

Economic Significance of Health Sectors in UK and Russia

% Global GDP in PPP HE % GDP

HE % Global GDP

US HE % Country GDP

USA 20.6 16.5 3.4 16.5

China 11.4 5.5 0.6 29.8

UK 3.2 8.4 0.3 106.3

Russia 3.3 6.0 0.2 103.0

Health and GDP 2008

50

Mortality and Life Expectancy: China, USA, Russia, UK

Indicators (2009) Units China USA Russia UK

Infant Mortality RateDeaths per 1,000

live births20.3 6.2 10.6 4.6

General Mortality Rate Deaths/1,000 7.1 8.4 16.1 9.3Life Expectancy at Birth, Total Population

Years 73.5 78.1 66.0 80.1

Sources: CIA World Factbook 2010

UK Health System Coverage of Population, Benefits and Costs in 1990, 2007



Public


0

100

100

100

UK Health 1990


UK Health 2007


Public

85.0 %

90.0 %

85.0 %

80.0 %


Parliamentary Report on Commissioning (Purchasing) in the UK NHS in March 2010

Conclusions from House of Commons March 2010 Report on Commissioning

• Expensive: rise in share of NHS administration from 5 % pre-reform to 14 % (lack of transparency)

• PCTs lack necessary skills (analysis, clinical knowledge, management), do ineffective job in commissioning

• Weaknesses of PCTs force them to make extensive use of expensive outside consultants

• PCTs remain weak relative to providers and do not insist on hospitals using evidence-based procedures

• Adversarial system without benefits. “After 20 years of costly failure, the purchaser/provider split may need to be abolished.”

Pre-Election 2010 Proposals for Change in NHS Structure

Parliamentary Election, July 2010 White Paper, December 2010 Health Reform Bill

• May 2010 parliamentary elections in UK. A government formed from a coalition of Conservative and Liberal Democrat parties.

• Neither party had radical reform of the NHS in its election manifesto

• July 2010 government published White Paper on Equity and Excellence: Liberating the NHS

• Proposes radical reforms to organisation and functioning of the NHS

Health and Social Care Bill: January 2011

• Abolish all 150 Primary Care Trusts and 10 Strategic Health Authorities

• Establish GP Commissioning Consortia– GP practices to continue to offer community based

services as independent contractors– But groups of GPs to form Commissioning Consortia

that will be NHS organisations and to be given £ 70-80 billion to purchase services

• Create new NHS Commissioning Board• All NHS Hospital Trusts will become Foundation

Trusts and be regulated by Monitor according to financial criteria

Proposed Changes in NHS Governance 2011

White Paper and Parliament Bill Proposals for 2013 NHS Governance

Political Actors Influencing 2011 Health Reform

Executive Government Legislature Political Opposition Non-Governmental (UK Shadow Government)

Opposition Party Leader

Party Leader

Prime Minister Cameron, Deputy

Clegg

Cabinet

Ministry of Health (Minister Lansley)

Defence Health Education

Professional Groups

Think Tanks

Media

NGOs

Public

Cabinet


Parliament

Regions

Districts

Medical Units

Committees, Commissions

(including Health)

Davis 2011

Coalition government proposes radical reforms

Many professionals within HS critical of reforms

Conservative party in favour, labour opposed, and Liberal Democrats divided over reforms

Shadow government strongly opposed to reforms

Almost all comments from non-governmental groups hostile to reforms

Opposition in Parliament and Among Members of Political Parties

• Labour Party official position is strong opposition to the radical health reforms. All relevant members of the shadow government have publicly criticised the proposals and members of the parliamentary party will vote against it.

• Liberal Democrat party is divided. 12 March 2011 LD party conference supported resolution condemning the reforms and putting forward alternative proposals (restrict power of GP consortia, limit private sector involvement, reduce use of market mechanisms)

Coverage of Health Reforms in Media• Most recent television reports and articles in

printed media have been critical of the health reforms

• 7 March “The non-national health service”• 10 March “Lib-Dems from top to bottom are in

revolt over NHS reforms”• 15 March “Doctors gunning for Lansley over

reforms”• 20 March “David Cameron's health reforms risk

destroying the NHS, says Tory doctor”

Opposition by Groups of Medical Professionals

• 15 March Special Conference of British Medical Association to discuss reforms. Almost all motions before conference are negative.

• Most doctors opposed to reform and believe it will result in a worsening of the quality of patient care and increased inequality

• 7 March Chairman of BMA Consultants’ Committee argues that reforms will damage management of the NHS, waste resources, and give the private sector the most lucrative components of treatment, with the NHS responsible for the unprofitable residual care

“David Cameron's health reforms risk destroying the NHS”: GP in Conservative Party

• "It is one thing to rapidly dismantle the entire middle layer of NHS management but it is completely unrealistic to assume that this vast organisation can be managed by a Commissioning Board in London with nothing in between it and several hundred inexperienced commissioning consortia.

• New commissioning consortia are "doomed to fail and will have to hand over their commissioning to the private sector".

• “An organisation responsible for £100 billion needs people who seriously understand accountancy and, trust me, GPs do not.“

• "It is no use 'liberating' the NHS from top down political control only to shackle it to an unelected economic regulator. If Monitor, the new regulator, is filled with competition economists with a zeal for imposing competition at every opportunity, then the NHS could be changed beyond recognition.“

Critical Analyses of Health Reform Proposals by Think Tanks (Nuffield, Kings Fund)

• Financial environment of reforms– Tight constraints on real health spending in NHS. PCTs facing 2% cuts

in real health spending. Need efficiency savings of £ 20 billion 2011-14.

– UK health spending (8.7 % GDP) low by OECD standards.

– Difficult to keep financial control during time of reorganisation

– Reforms require better management, but overall NHS target of 45% cut in management costs over next several years.

• GP Consortia– Past experience with GP fund-holding reveals many deficiencies. Years

needed to develop necessary expertise. GP Consortia won’t have necessary competence in commissioning and planning.

– GP Consortia should be subjected to same critical evaluation as NHS Trusts currently receive. Should have to prove themselves.

– Need safeguards to prevent conflicts of interests of GP Consortia

Critical Analyses II• NHS Commissioning Board

– New Board will play important role. Will be able to intervene in work of GP Consortia.

– But lack of clarity of functions and accountability of Board. Experience from New Zealand reforms not positive.

– Unclear if Board can ensure high standards in both GP commissioning and provision of medical care.

• Abolition of Strategic Health Authority– Huge reorganisation will distract management and entail

substantial additional costs– Will result in loss of experience leadership with long-term vision

because not many managers will transfer to GP Consortia • NICE

– New freedoms to GP Consortia raise possibility that they will not adhere to standards developed by NICE

– Conservative government not supportive of quasi-governmental organisations

Conclusions• UK NHS has been performing well over past

several decades given tight financial constraints• NHS has been subjected to many reforms, not all

of which have been successful• New radical health reforms promise to reduce

bureaucracy, improving efficiency and quality of care, providing more choice for patients

• But most independent analysts highly critical or reforms and most political forces against it

• Modified version of bill is likely to be adopted, but the reforms will not deliver promised results

Radical Reform of the National Health Service in the UK in 2011: Background, Proposals, Prospects,...

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