NHS reforms deliver no significant patient benefit

Rhetoric not matched by results

Almost 1 billion pounds spent increasing choice and competition in the health service has not delivered any significant benefits for patients, an official report published today says. Changes intended to introduce "market style" reforms in the NHS have delivered some improvements, the Audit Commission and Healthcare Commission concluded. But there was still "some way to go before patients see any significant benefits", said Ian Kennedy, the chairman of the Healthcare Commission, who co-authored the report. Around half of patients are still not being offered a choice about where they would like to be treated, the report found

The changes have also failed to increase the number of patients being treated outside hospital, one of the key aims of the reforms. Although there have been "significant improvements" in some areas, the report concluded that progress was "behind" what it might have been.

The reforms, brought in at different points since 2000, include allowing patients more choice about which hospital they visit, increased use of the private sector and paying hospitals a set rate for each procedure, encouraging them to treat more patients more efficiently. But they were introduced with no clear "vision", the report found, and no system was set up to monitor or evaluate if they were working.

In 2006 ministers announced that patients would be allowed to choose between a limited number of hospitals for their care, a policy extended to all hospitals earlier this year. However, the report found that only 50 per cent of patients were being offered any choice at all, well short of the government's target of 80 per cent. The health service also does not collect enough information to allow patients a true choice, the report found. Most patients want details on the quality of care provided by different hospitals but that data is not being collected by the Department of Health.

The report also shows that outpatient appointment numbers remained generally static across the country, despite a stated aim to treat more people in the community instead of in hospital. And only 16 per cent of GPs believe that a new system which gives them more control over money spent by their surgery had actually helped patients.

However, the report's authors said that the reforms could deliver benefit to patients in the future. "Conceptually the measures should work and we should look to the start of improvement. In the next couple of years we will know whether the idea was correct," Michael O'Higgins, chairman of the Audit Commission, who co-authored the document, said.

The Tories accused ministers of missing "a golden opportunity" to make a real difference to standards in the NHS. Andrew Lansley, the shadow health secretary, said: "They have spent a lot but achieved far too little. "The Government has said many of the right things about reforming the NHS but when it comes to actually delivering them, it has dithered and delayed. Giving GPs responsibility for budgets for their patients should have been one of the strongest drivers of change but Labour hasn't implemented it. "Too much money that could have been spent on improving care for patients has been wasted."

Norman Lamb, Liberal Democrat health spokesman, said: "This is a depressing verdict on 11 years of endless, contradictory reform in the NHS which have cost taxpayers a lot of money and delivered little benefit to patient care. "Choice in the NHS must be made to work for everyone. Without information and support for all patients, choice will succeed in only improving care for the well informed - leaving more disadvantaged groups behind."

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