DO THE NHS REFORMS MAKE SENSE?

Julian Le Grand, London School of Economics Bristol conference 28/1/06

Long waiting lists
Inefficient use of capacity. 98% of pop lives with 1hr travel time of 100 available and unoccupied NHS beds. 76%, within 500.
Unresponsive to patients’ needs and wants
Poor on innovation
Only better off had opportunity if dissatisfied to go elsewhere.
Inequity within the NHS.
Monopoly of provision

Unemployed, and individuals with low income and poor educational qualifications use health services less relative to need than the employed, the rich and the better educated.
Intervention rates of CABG or angiography following heart attack were 30% lower in poorest group than in the richest.
Hip replacements 20% lower among poorer groups despite 30% higher need.
A one point move down a seven point deprivation scale resulted in primary care practitioners spending 3.4% less time per consultation

Effect of targets on waiting list for hospital admission England

Effect of targets on patients waiting more than 12 months including Scotland

Effect of targets on patients waiting more than 12 months including Wales

Effect of targets on patients waiting more than 12 months including Northern Ireland

Numbers waiting more than 4 hours in casualty 2002-5

Patient choice. Intrinsic and instrumental.
But, if choice is to provide the right incentives, needs reward for success, penalty for failure. HenceBR – money following choice.
But also choices must exist. Evidence that new providers offer most effective contestability. Hence Independent Sector Treatment Centres and Foundation Trusts.
But danger of over-treatment. Hence Practice Based Commisioning.

We are not looking for the best system, but only for the least worst.
Reformed NHS is likely to be the least worst but there are risks along the way.The challenge is to deal with those risks in the most efficient and equitable way.