Report proposes more NHS reforms

BMJ 1996; 312 doi: (Published 13 January 1996) Cite this as: BMJ 1996;312:78
  1. Claudia Court

    Successive reorganisations of the NHS since 1979 have led to increasing fragmentation of the service, says a discussion paper published this week. The paper, from the left of centre Institute for Public Policy Research, says that patients have become “merely a sort of currency” and that the effectiveness of the service is under threat. The report ironically proposes yet more reforms as a solution.

    The authors say that endless reorganisation of the health service has resulted in relationships “in which everything must be defined, costed and documented and in which patients are merely a sort of currency for organisational transactions. The results are secrecy and non-cooperation amongst staff.”

    The authors want to see included an end to the expansion of general practitioner fund-holding in its current form. Other proposals include reconstituting regional health authorities and funding them from the bottom upwards; and restoring national pay agreements (but with trusts having greater flexibility in pay than was the case before 1991).

    The report says, “The single most fallacious assumption which underpins the purchaser/provider split is a picture of medical practice in which the patient has a discrete encounter with the health system, from which he or she emerges either cured or dead.”—CLAUDIA COURT, BMJ

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