Throughout the parliament, the NHS has come under pressure from constrained resources and rising demand for care, with an increasing number of providers falling into deficit and targets for patient care being missed.
This report covers six major themes of the coalition government’s reform programme:
- commissioning of care
- provision of care
- regulation of care
- governance and accountability
- integration of care.
For each theme, it describes the situation the coalition government inherited when it came to power in 2010, the policies it has pursued, and (where available) evidence of their impact.
This report concludes that the:
- coalition government’s reforms have resulted in greater marketisation of the NHS but that claims of mass privatisation are exaggerated
- reforms have resulted in top-down reorganisation of the NHS and this has been distracting and damaging
- new systems of governance and accountability resulting from the reforms are complex and confusing
- absence of system leadership is increasingly problematic when the NHS needs to undertake major service changes
- Care Act has created a legal framework for introducing a fairer system of funding of long-term care.
- The next government should continue the emphasis on patient safety and quality of care but with less emphasis on regulation and more on supporting NHS leaders and staff to improve care.
- Further top-down reorganisations must be avoided, but evolutionary and bottom-up changes to the organisation of the NHS are needed to reduce the complexity and confusion of the structures introduced by the coalition government and to allow the implementation of the NHS five year forward view.