Health White Paper reforms cannot be delivered without the right investment and public support
PA Consulting Group surveys public in response to the White Paper “Equity and Excellence; Liberating the NHS”
The vision for the NHS detailed in the White Paper has the potential to deliver real improvements, but investment is needed to enable clinicians and GPs to succeed. According to a PA Consulting Group YouGov survey of over 2,000 members of the public1, confidence in the Government’s proposals to make local GPs responsible for planning and buying the great majority of NHS services for their patients is low - only 21 per cent of the general public thought this would be likely to improve the quality of health services in their area.
Nearly half (48 per cent) of the general public don't trust their local NHS to engage effectively with the local population regarding proposed changes to or closures of NHS services within their area.
Andy Mullins, head of health at PA Consulting Group says:
“The White Paper reforms represent the biggest change to the NHS since 1948. For them to be successful the Government will need to resist the temptation to interfere with local decisions, invest in management capability (contrary to their current direction), develop new information systems to support better commissioning decisions and perhaps surprisingly, more regulation to ensure the new market works effectively.”
How can the White Paper reforms be effectively implemented?
PA has identified four ‘pillars’ that will be key to the effective implementation of the White Paper reforms.
Pillar 1: Clinicians and local GPs must be given the powers to innovate and deliver local service changes. 46 per cent of respondents said they were more likely to support proposed changes to or closures of health services within their local area if they were supported by local GPs and hospital doctors. Clinicians and GPs must be given the capabilities and freedom from political and central interference to effectively deliver change.
Pillar 2: We need better and possibly more, not less management. The NHS target for management cost of 0.6 to 0.8 per cent of the £70 billion GP Commissioner budget is over ambitious. Private sector companies often spend 10 to 15 per cent of their turnover on management and highly rated charities spend 4 to 8 per cent - the American Cancer Society spends 7 per cent for example. If central targets for management costs are imposed there is a risk that commissioners will be set up to fail before they start. GP Consortia should be given the freedom to spend whatever they need on management, but held account for outcomes.
Pillar 3: Information management and investment in IT is not a luxury. Data alone is not enough, we need more investment in information systems to present data carefully so the right clinical decisions can be made. Clever and sophisticated analysis will get lost without up front investment to build systems to improve data quality. Government should avoid imposing caps on spending on information and encourage experimentation in the best ways to share data. Failure to invest will lead to worse decisions being made, which can cost lives and impact on spending budgets.
Pillar 4: We will need more regulation not less to create a level playing field for effective competition to develop. Experience from other markets shows that a detailed, long term regulatory approach is necessary in order to truly open up the market and ‘free NHS providers’. GP commissioners are likely to have a preference for existing suppliers as they will struggle to challenge the traditional power bases of secondary care providers. In the telecommunications sector, for example, it has taken 20 years to develop the market and subsequently for the regulator to reduce its powers.