Should we have a royal commission on the NHS?BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1621 (Published 06 April 2017) Cite this as: BMJ 2017;357:j1621
All rapid responses
Nigel Crisp is correct to say no. This would take years. A better approach would be the all party committee suggested by Norman Lamb to examine all aspects of the NHS including funding.. Many of the problems are fairly obvious to those working in the NHS and could be addressed. Here are two.
The NHS needs more money and to make huge savings. However most politicians would not admit that the present system of commissioning and procuring services involving multiple contracts with different providers with liability to legal challenge from European competition rules is hugely expensive and wasteful. Even before Lansley’s reforms, the commissioning process was estimated to consume 14% of total NHS costs. These changes, estimated to cost £3 billion, to implement removed the strategic health authorities through which services could be planned and service reconfigurations could be achieved. Large sums are now spent on management consultants to undertake this work. Healthcare, just like defence, needs to be planned and not left to market forces. The integration of health and social care forms an important part of the Five Year Forward View and should help in keeping people out of hospital.. However, these changes require careful planning and do not sit comfortably with the business culture of the internal market which is responsible for some of the unsatisfactory attitudes and behaviour of both some NHS organisations and staff. Competition between health providers has been seen as the best way to motivate people in the NHS and to improve efficiency. It does not and is hugely costly. The priority therefore should be to encourage the collaborative working between primary and secondary care and other providers and to abandon the purchaser provider split as soon as possible as envisaged in Accountable Care Organisations. A return to planned health care should result in huge savings.
The shortages of doctors and nurses in primary care and parts of secondary care and other parts of the NHS need to be remedied by effective manpower planning. We need to improve retention by removing the blame culture which is so prevalent and reducing the pressure on staff. All staff need to feel valued and that their work is rewarding. Hospital doctors in training need to work sufficient hours under supervision to gain the necessary experienced and provide continuity of care. Many would value a return the ‘firm’ system so that they feel part of a team. Nine out of ten hospital trusts are in financial deficit not only because they are not being paid appropriately for their work but also because of increased staffing costs from having to employ more staff often from agencies to comply with safety standards. Ensuring a sufficient supply of all types of trained staff would reduce these costs.
Competing interests: No competing interests