The coalition government has not learned the lessons of past reorganisations of the NHS and is intent on more massive change without evidence that it will improve the service, Kieran Walshe, professor of health policy and management at Manchester Business School wrote.
Despite having promised only two months ago that there were would be a ‘stop to top-down reorganisations of the NHS’, the biggest changes are now planned for a generation, he said.
“Little of the current architecture of the NHS will survive these changes unscathed,” Prof Walshe wrote.
Meanwhile and editorial in The Lancet medical journal also hit out at government health policy after finding evidence of cuts to vital mental health services in Oxfordshire despite Andrew Lansley, the Health Secretary, pledging that frontline services would be protected from austerity measures.
Prof Walshe said in the British Medical Journal that ministers were about to repeat the mistakes of the past.
He wrote: “The white paper, written at breakneck speed in about six weeks, is long on rhetoric but short on detail and specifics. It promises at least seven further strategy or consultation papers on various topics and another white paper, on public health, in the autumn.
“For someone who has spent more than six years mastering the health brief in opposition, Andrew Lansley seems to have learnt little from the history of NHS reorganisation.”
He said there have been 15 major structural changes to NHS organisations in the last 30 years and there is ‘little evidence’ that they produced ‘much, if any, improvement’.
The white paper includes plans to abolish primary care trusts and strategic health authorities and instead force GPs into contortia to purchase care from hospitals and other health providers for their populations.
However Prof Walshe said there was little evidence to suggest any of the methods for commissioning care, either primary care trusts, GP fundholders or external support agencies, were any better than each other.
Many different ways of commissioning care have been tried and Prof Walshe said there is nothing to suggest that any of them were better or worse than the others nor that the new GP consortia will fare any better.
He wrote: “The transitional costs of large scale NHS reorganisations are huge, although they are often discounted or ignored, and the intended or projected savings from abolishing or downsizing organisations are rarely realised.
“Closing down or merging organisations produces a round of expensive redundancies, early retirements, and redeployment, while new organisations find new premises and appoint lots of new staff.
“On the basis of the National Audit Office’s survey data, I estimate that the proposed NHS reorganisation will cost between £2bn and £3bn to implement, at a time of unprecedented financial austerity.”
He said whether abolishing primary care trusts and strategic health authorities in order to set up GP consortia, which may number in the hundreds, will save any management costs remains to be seen.
However he warned that over the past twenty years the number of managers and management costs have grown steadily.
The actually process of reorganising the NHS is also a distraction from delivering care to patients as it takes a ‘massive amount’ of managerial and clinical time and effort, he said.
“It saps morale and creates uncertainty for many people about their careers and futures. In addition, new or merged organisations take time to become established and start to perform well, ” Prof Walshe wrote.
If the reforms go ahead then government must set out the intended costs and benefits which should then checked and the results presented to parliament.
A spokesman for the Department of Health, said: “We do not recognise the £3 billion figure cited in this report.
“The reforms proposed in the White Paper will cut the cost of bureaucracy, saving money that can be used to improve the quality and efficiency of the NHS.
“The costs associated with and the savings generated by our reforms will be published later this year, but the reductions in management costs we have already announced will save £850 million each year from 2013-14 alone.
“The reforms will not adversely affect patient care, In fact, they will do the opposite, putting patients first and making health outcomes the best in the world.”
The Lancet medical journal called on Andrew Lansley to be truthful about cuts to patient services after uncovering evidence that clinicians would lose their jobs in planned cuts in Oxfordshire.
The NHS has been told to find between £15 billion and £20 billion in “efficiency savings” over the next few years.
But the editorial said Mr Lansley has promised that efficiency savings will be “reinvested in frontline services”.
Yet a document handed to the journal shows that many jobs will be lost and patients affected by cuts at Oxfordshire and Buckinghamshire Mental Health NHS Foundation Trust, which needs to save £5.3 million over the next four years.
The document acknowledges “poorer” services for patients as a result, with “reduction in quality of service through staff changes” alongside “patient and carer dissatisfaction with the service”.
The editorial said: “The Oxfordshire experience might be common.
“This is an issue that challenges a fundamental commitment by the Liberal-Conservative coalition.
“And this is why we ask: Mr Lansley, will you tell us the truth about NHS cuts? Because the reality seems very different from your promise.”