Reforming the NHS: Have we gone too far or not far enough?

October 06, 2005

The NHS is being taken over by big business so that money that could go towards clinical care is diverted to corporations and their shareholders, warn two senior doctors in this week's BMJ.

Robert Lane and Alex Paton argue that huge amounts are paid to large private firms for advice about the Private Finance Initiative (PFI) and independent sector treatment centres (ISTCs). Profits are then swollen by the scandalous practice of refinancing buildings, while cash-strapped hospitals must pay the mortgage for 30 years.

But problems go deeper than money, they say. While clinicians are expected to provide evidence to support the actions they take, ideas generated by government advisers are often applied without consultation.

"The result is a stream of untried schemes, based on ideology rather than evidence, that often have unforeseen consequences on different parts of the NHS."

But for those in favour of reform, the problem is not that we have gone too far but that we have not yet gone far enough. In a second article, Jennifer Dixon calls for full implementation of the reforms already designed (payment by results, patient choice, and provision of care by non-NHS providers).

"The supply of private providers must continue to grow," she says.

But she also wants more. Key elements, such as stronger financial incentives, boosted commissioning, and effective economic regulation, are urgently needed. The government must also provide more evidence that the risks of reform on this scale can be managed effectively, she concludes.


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