Human and economic costs of NHS reforms David Nicholson, the NHS chief executive, has raised alarming questions about how the NHS can be paid for (NHS chief: cuts alone will mean more Staffords, 11 July). Throughout a working lifetime as a GP, I have carefully watched many changes. I now have a pragmatic but retro-radical suggestion: we should abolish the internal market and thus such subordinate institutions and devices as the purchaser-provider split, autarkic and competing trusts, payment by results and commissioning. All of these may be well intended but collectively are a failing experiment to apply commerce and monetarism to complex welfare. The human and economic costs of this defederalised system are very high. As fragmentation and boundaries increase, so do procedural, bureaucratic and financial complexity and delay. Competition, or its threat, decreases professional synergy and replaces it with expensively expedient tactics and presentations: glossy brochures, specious statistics, mistrustful feints, "gaming" the systems and being guided more by technical legality than humanistic ethos. I have hundreds of examples, but rarely (if ever) do I discern clear benefits of defederalisation. guardian.co.uk/society/2013/jul/15/human-economic-costs-nhs-reforms
Posted on: Tue, 16 Jul 2013 08:49:13 +0000