Incoherent policies and excessive change undermine health strategy

BMJ 2004; 329 doi: (Published 16 September 2004) Cite this as: BMJ 2004;329:639
  1. Caroline White
  1. London

    Incoherent policies and constant structural change are undermining the UK government's blueprint for health service improvements and fostering a culture of distrust, concludes a swingeing critique published this week.

    Lost in Translation, from the NHS Plan Working Group, is the third in a series of reports on the government's progress in achieving its stated aims for modernising health services, set out in the NHS Plan in July 2000.

    The report, which covers health inequalities and public health, regulation and inspection, and public and patient choice, acknowledges that “important improvements have been made.”

    But it goes on to say that “it is unclear whether these are sustainable in the long term.” The report also questions Prime Minister Tony Blair's strategy of “disruptive governance” in a bid to shake up thinking.

    Among its key messages, the report contends that the mantra of patient choice has not been properly thought through and may actually widen health inequalities and undermine public health initiatives.

    The government's belated recognition of the importance of public health is to be welcomed. But it must show that it is fully committed to this in the long term, cautions the report, adding that the government should adopt a more interventionist approach.

    Targets have worked, but “now risk becoming increasingly counterproductive to good management and the exercise of professional judgement,” contends the report, describing the weight of targets and inspections as “punitive and excessive.”

    The report also criticises the overemphasis on repeated structural change, while ignoring cultural change. This approach has been expensive and bewildering and is one that will not achieve the government's vision of a patient centred NHS, it warns.

    One of the report's authors, David Hunter, professor of health policy and management at the University of Durham, said that the prime minister and Alan Milburn, former health secretary, were “obsessed with change.”

    “They think it's part of the solution. But it's also part of the problem… People need to consolidate.”

    Professor Hunter claims that the government continually dismisses the concerns of NHS staff on the grounds that they do not like change and “openly distrusts the very people it needs to solve the problems,” while finding it hard to resist “meddling and interfering.”

    Lost in Translation can be obtained by contacting Christine Jawad on tel +44 (0)191 334 0360

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