Intended for healthcare professionals

News BMA annual representative meeting, Belfast, 26 June to 29 June

Doctors blame untested policies for financial crisis in the NHS

BMJ 2006; 333 doi: (Published 29 June 2006) Cite this as: BMJ 2006;333:9

Evidence-based managment consultancy

In response to Mr Black, there is no evidence that the
(re)introduction of the internal market (as Practice-Based Commissioning
and Payment By Results, in place of fundholding) will lead to significant
improvements in population health. Comparison of UK and USA population
health indicators show, in virtually all cases, that the market-driven US
health system fails to deliver across the whole population compared with
the UK. We can do better, but moving towards privatisation is not the
direction we should take.

Indeed, there are major concerns that the introduction of market
principles such as practice-based commissioning and redirection of
finances into the associated administration will serve only to worsen
health inequalities for the most deprived populations. The replication of
US style health systems in the UK, delivered by giants like United Health
Europe and Kaiser Permanente, will not provide quality care for those with
the least ability to exercise 'choice' - the poorest in our society. Most
patients do not want to 'choose and book' from a plurality of competing
providers miles away from their homes - they want good, locally delivered
health care that is accessible and equitable.

The NHS is currently undergoing yet another demoralising service
reorganisation, led in the main by a vanguard of external management
consultants and private providers who stand to pick at the choicest meat
from a dying NHS carcass abandoned to profit seekers. The NHS spent over
£1 billion on 'advisors' who seem to have a tenuous grasp of the clinical
realities of delivering high quality services across populations with
widely differing health needs. While clinical staff are increasingly
required, quite correctly, to base their clinical and public health
interventions on solid research evidence, there appears to be no
equivalent requirement for management consulting interventions to be
evidence-based. The introduction of untested management theories is mainly
to provide political capital to be seen to be 'doing something' and to
dismantle covertly for profit an NHS/social care system which is already
highly efficient compared to other health care models.

When the vultures have finally flown away, bellies full, what a
pathetic skeleton service will remain for the most disadvantaged people in
the UK. It is time to depoliticise the NHS, and to prevent politicians and
businesses solely interested in the profit margin from abandoning the
health needs of the poor.

Competing interests:
Doctor working in the NHS who is is a supporter of 'Keep The NHS Public'

Competing interests: No competing interests

05 July 2006
Alan A Woodall
GP trainee/SpR Public Health
Shrewsbury and Telford Hosptal NHS Trust