The United Kingdom’s broken promises on health

Before the current coalition government came to power in the United Kingdom in 2010, its dominating conservative partners promised that there would be no top-down reorganisation of the country’s National Health Service (NHS). Yet this same government is now steamrolling through what one leading UK doctor recently described as “the mother of all top-down reorganisations”.1 In response to the public outcry and opposition from just about every Royal Medical College nationwide, the government announced, in 2011, a “pause” in the progress of the Health and Social Care Bill, so it could “listen” to concerns. Prime Minister David Cameron reportedly told frustrated doctors and nurses: “We are taking this time to pause, to listen, to reflect and to improve our NHS modernisation plans. Let me be clear: this is a genuine chance to make a difference.”

The most controversial proposals are those that make it easier for private firms to provide health care, structural changes that could destabilise the NHS, and the removal of strategic health authorities and their replacement with groups of general practitioners who will directly commission services for their local area. But in any case, early in 2012, the legislation was passed with all of its central (and controversial) pillars essentially intact. The government faced accusations that the “listening exercise” was an empty gesture and a publicity stunt.

A depressingly familiar theme emerges, and Australians who follow political goings-on in their country will recognise it: our political leaders, wherever or whoever they may be, might like us to think that their door is always open, that they listen, respect, care (or choose any other platitude). But in this case, decisions on big ticket issues in UK health reform may have been made long before the first stop on any listening exercise.

In the UK, the furore over health reform continued unabated throughout the past year. Health Minister Andrew Lansley was removed from his post in the first major reshuffle by Cameron in September, because of multiple protests and votes of no confidence. The Labour opposition spokesman on health (and former Health Secretary) Andy Burnham has been unrelenting in his attacks. Labour says that the coalition has no mandate to spend billions on fixing an NHS that isn’t broken. Burnham argues that the NHS in its current structure is best placed to meet the UK’s future health challenges and has pledged to tear up the reforms if Labour wins the 2015 general election.

Cameron’s government has made some other promises on health, including that the NHS budget would be ring-fenced from austerity cuts and that front-line health services would not deteriorate under its stewardship. The strains of this commitment are already showing. A number of reports at the end of 2012 have painted a picture of a health service struggling against a tide of challenges. The King’s Fund, a London charity and think tank, concluded that although care in the NHS was generally holding up well, increasing numbers of NHS Trusts (the incorporated public sector entities that manage health care services at a local level) are facing financial difficulties, and there are alarming signs that waiting times in accident and emergency departments are increasing.2 This was backed by a patient survey published by the Care Quality Commission (CQC) responsible for inspecting health and social care in the UK.3 In its State of care report 2011/12, the CQC also found common areas of failure relating to dignity and respect, nutrition, and care and welfare across the health service.4 Finally, UK hospitals were described by one expert report as full to bursting, with an average mid week bed occupancy rate of 88% compared with the target of 85%.5 At one point during the winter peak early in 2012, two-thirds of hospitals had 95% or higher occupancy rates.

The complex reforms and increasing financial strains in every part of the NHS make it almost inevitable that patient care will suffer in the remaining years of this government. Perhaps Cameron should avoid making any new promises on health during 2013 — the odds are against them being kept.