King’s Fund calls for brake on reforms

The case for reorganising the NHS in England has not been made and health ministers should reconsider the speed and scale of their proposed reforms, the King’s Fund has said.

In its response to the Department of Health consultation on the white paper ‘Equity and Excellence: Liberating the NHS’, the health charity has questioned the need to embark on a fundamental reorganisation of the health service.

The coalition government plans to abolish primary care trusts and strategic health authorities and give control of 80% of the NHS budget to GP commissioning consortia.

It also plans to make all trusts foundation trusts and to give patients new choices over their treatment.

The King’s Fund said evidence showed that health outcomes and public satisfaction with the NHS had improved in recent years. It argued that the reforms could distract attention from the need to find efficiency savings and maintain quality services.

The charity said it supported moves to give GPs a stronger role in commissioning services, to extend choice for patients and to enhance the role of local authorities in the health and social care system. But it questioned the need for a widespread NHS reorganisation.

It called for the government to streamline NHS structures over time as new consortia get up to speed instead of abolishing PCTs in 2013.

It also argued that GP consortia keen to get on with commissioning could be given ‘real’ budgets now so their experience could be used to inform national roll-out.

The King’s Fund said large cuts in management costs and the abolition of PCTs and SHAs would incur costs and make it difficult to ensure there is effective change management in place to support implementation of the proposals.

The health charity also said the government was right to recognise the importance of information not only to support choice but as a key driver of improvement in its own right.

However, it said few patients make use of publicly available information on the quality of providers and many people find it difficult to understand and interpret data about the quality of providers.

The King’s Fund paper adds: “If patients are to make more use of publicly available information on the quality of providers, the information needs to be relevant, accessible and presented in a way that patients can understand.”

Professor Chris Ham, chief executive of the King’s Fund, said: “I hope ministers will think again about the plans for implementing these proposals. This does not mean putting the brakes on across the board. In some areas, they could in fact move more quickly by beginning to test out and evaluate how key elements of the reforms will work in practice.”