Well if you were only to consider the improvements made in terms of cardiovascular services - which constitute a third of all mortality, then England has made huge strides (the UK as a whole has been less successful - but then devolution does mean that you can do things differently). But the government can only see unsubstantiated claims from consultancies which have access to the department the even the most senior partners in the NHS don't. In the last 4 years alone, three programmes 'PCT fitness for Purpose', 'World Class Commissioning' and FES support for commissioning' have poured many millions into the coffers of the consultancies. The programmes are just rehashed versions of each other, and now the goverment promises yet another programme of commissioning support for CCGs - probably with the same firms. And then we have people complaining about the number of managers in the NHS!!!!
I continue to be astounded at how the case for these reforms has been presented, with such superficial, selective analysis and shallow arguments for the proposed changes - now essentially 'de facto' because of their implementation in advance of legislation: such a 'bulldozer' approach that belittles both the importance of the NHS in our society and the views and experience of those that serve within it. The NHS is not perfect, it needs to change and improve, and it's a complex system - but that is best tackled with depth of analysis and understanding, and addressing the challenges that really matter. One suspects that ideology is driving the current reforms, not logic nor open debate. I feel for those working in the NHS undergoing yet more radical changes, and I fear for whatever the result might be for all of us as patients.
Dr Tomlinson, this is very interesting, thank you. I have wondered for a long time who was advising the DH. I have worked in parts of the NHS where change has been in progress, such as ISTCs and Polyclinics, and alongside McKinseys. Their lack of practical experience and inability to understand detail in the system worried me and my suspicion they were involved has been confirmed. I agree with Chris's analysis, the NHS is not perfect but in context improvements such as hitting 18 weeks and 4 hrs, are mind blowing examples of successful change. Why then the wholesale change?
Would you like to comment on the Nicholson challenge (McKinsey challenge?) Given that the NHS has a world reputation for parsimony and has only very recently reached average european spending on health, most people are bewildered that the McKinsey report (which wouldn't have passed muster if an undergraduate had handed it in) is the basis for what Stephen Dorrell has described as the revolutionary part of the reforms and a Tory Peer told me would 'destroy the NHS'