Friday, 18 February 2011

Lack of evidence to support NHS proposals

Some useful statistics in this Letter from The Guardian:

Simon Jenkins' fulminations about the national health service (The cure for an ailing, ageing NHS is to cut it down to size, 16 February) come only a few days after Ben Goldacre's splendid expos̩ of cherry-picking by health ministers in choosing which facts suit their ideology (Bad Science, 12 February). Simon is similarly highly selective with his "evidence". Stigmatising 24,000 people as "back-office staff" and "bureaucrats" is very lazy thinking. They are the focus of the government's aim of 30% savings in administrative costs and 45% savings in management costs within four years Рa target which has not been achieved by any comparable organisation worldwide within public and private sectors.
Here is some evidence he ignores. NHS managers represent 13% of the total workforce. The proportion of managers in the UK workforce is 16%, so it could be argued that the NHS is under-managed. The administrative costs in the NHS are 5% (among the lowest in the developed world) but in the US (surely the model Jenkins admires) they are at least 20%. The proposed NHS reforms could therefore end up with a higher proportion of the budget being spent on administration. NHS productivity is claimed to have fallen every year – but no one has ever devised agreed metrics for what "productivity" in healthcare actually is, nor how it can be squared with improved quality of clinical care or the patient experience.
Simon ignores the fact that it is only the NHS in England which is proposing this leap in the dark which Lansley's "reforms" represent. Scotland, Wales and Northern Ireland want nothing to do with it. Simon forgets that the creation of the NHS was in response to the poor service previously delivered by the patchwork of charitable and municipal hospitals to which he looks so nostalgically – it was a political act in response to public concern about variable service which involved a degree of centralisation. The NHS has always struggled with the "democratic deficit" which that entails, but we should be highly sceptical that turning over funding to GP consortia where there are no nominated (never mind elected) representatives of the public is the way forward.
John Edmonstone
Littlethorpe, North Yorkshire

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