Feature NHS reforms

How do we evaluate the impact of the health reforms on the NHS?

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e5539 (Published 21 August 2012) Cite this as: BMJ 2012;345:e5539
  1. Zosia Kmietowicz
  1. 1London

The Health and Social Care Bill came into force in March after much controversy, but how will we know if it’s good for public health? Zosia Kmietowicz asks doctors, health economists, and policy advisers

Even before it was put before MPs in January 2011 the Health and Social Care Bill was steeped in controversy for the monumental structural changes it would impose on the English NHS. By the time it received royal assent in March 2012 the 473 pages of legislation had been subjected to the most parliamentary scrutiny for nearly 20 years.

On the day it became law health secretary Andrew Lansley said the act would devolve power to doctors, give more choice to patients over how they are treated, drive up quality, enable integration, and reduce bureaucracy in the NHS. Local democratic involvement and public health would also be strengthened.

But how will we know if the act is good for the public’s health? We asked a range of doctors, health economists, and policy advisers what measures we could usefully look at to judge the impact of what Mike Farrar, chief executive NHS Confederation, described as “among the toughest projects the NHS has ever taken on.”1

Nick Black

professor of health services research, London School of Hygiene and Tropical Medicine, and chair, Department of Health National Advisory Group for Clinical Audit and Enquiries, London

It’s unlikely we will be able to determine the impact of any healthcare reforms for at least a few years. We only have to look back at GP fundholding to see an example of a reform that wasn’t given long enough for clear evidence of its impact to be rigorously determined.

Most of the government’s aspirations are motherhood and apple pie; what’s not to like about “ensuring a focus on integration” or “strengthening public health?” While these goals are also notoriously difficult to measure objectively there are a couple of aspirations that we could look at dispassionately: “drive up quality” and …

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