Why the NHS reforms are now not radical enough

 By boliston

So in one bound, the coalition has leapt triumphantly into embracing a wholly different series of NHS reforms.  Instead of GPs driving forward the commissioning process, there will be appointees representing hospital doctors, nurses and others. 

The brave new compromise looks a great deal more like the old PCTs, which are still twitching away prior to being dead and buried.

The compromise is certainly a triumph for a certain kind of democracy.  The argument inside government was almost entirely transparent.  The consultation has brought various excluded professionals back on board.

The question now is whether it will make the changes necessary.  Because we should not pretend, as the opposition does, that somehow the NHS is a blemish free national jewel.

Let’s leave aside for a moment the treatment of older people on geriatric wards, and the McKinsey-style tick box systems at the heart of everything – not forgetting the huge waste at the heart of the produce-provider split (batteries of administrative coders on £1,000 a day).

No, the main problem is that the NHS will not survive in its current form unless it addresses the central problem – its relative inability to tackle growing chronic ill-health, which sucks up 80 per cent of its time and a similar proportion of resources.

The truth is that it is easier for our institutions to maintain huge numbers of patients with their asthma, back pain or depression for the rest of their lives, with the help of vast quantities of drugs, than to find the new forms of treatment that can provide them with permanent relief.

Tickbox cultures encourage pill-popping solutions, so perhaps this is no surprise.  But the health policy world still has no clear concept of a prevention agenda – what they mean by prevention is actually early detection, another matter entirely.

There was little chance that raw competition from American health giants, and the virtualisation of medicine, would have made this urgent shift possible.  Quite the reverse.

But preserving the status quo, as the new version of the reforms seems to do, seems unlikely to do so either.  But one change would do more than anything else to usher in the new world of a seriously preventative NHS.

It is this.  Every contractor, voluntary or private sector, with an NHS contract will need to show how they will reduce demand over the period of that contract.

They will need imagination to do that, to work out how to reach upstream of the problems they are tackling. They will need resources to create the preventative infrastructure of time banks and mentors that we are going to need. These reforms seem unlikely to do either.