The truth’s out about “reforms” in the English NHS

This article is from the Welsh Communist Party blog – remember, we’ve not got devolution in England, unlike Wales.

Wednesday 26. March
JULIAN TUDOR HART explains why new evidence casts doubt on government claims on the impact of its ‘reforms’ on NHS England.

WHEN Edwina Hart took office as Wales Assembly government minister for health, she quickly made clear her intention to renationalise NHS Wales, close the door to all further privatisation and eliminate the purchaser-provider split as soon as she could get past her civil servants.

Important though this is, it probably scarcely registered with the Welsh general public until she announced the impending end of all charges for hospital car parking – an immensely popular step that was widely welcomed.

As new Labour at Westminster is still driving ahead with its privatisation programme, with plans for giant polyclinics all over London the latest plank, an explosion of some sort was bound to come sooner or later. Free parking for patients and visitors has now lit the fuse.

Retaliating recently, Junior Health Minister Ben Bradshaw said: “If that’s what Scotland and Wales want to do, that’s one of the joys of devolution. We’re spending the money on improving patient care. In Wales, you have to wait much longer for your operation, you have to wait much longer in A&E. You’re not going to enjoy the extended GP opening hours that patients in England are soon going to be enjoying.

“Those are the priorities that we think the English patients are more interested in, rather than subsidising anyone who wants to park in a hospital car park for free.”

Bradshaw’s confident assertion of NHS England’s superiority to NHS Wales is only the most recent of many on the same lines. So far, these claims have remained pretty much unchallenged by the medical or Civil Service establishment.

Now, under the heading England’s waiting times no better than Wales, the Health Service Journal has produced expert evidence from Paul Robinson, head of market intelligence at the NHS informatics supplier CHKS, that, despite England’s much larger investment in waiting-time reduction, average waits have fallen at a similar pace to those in Wales.

Robinson goes on to say: “This raises a big question about what is needed to reduce waiting. Wales has not made a large-scale investment. Did England need to spend so much and to develop a plurality of providers in order to achieve its waiting-time gains?”

A recent report from the independent charity Civitas on waiting times in England suggested that, although the longest waits have shortened, the median wait has not changed significantly.

In other words, the main impact of the waiting times initiative has been to tighten up the distribution of waits so there is a much shorter “tail.”

Robinson analysed waiting times across the last five years for four procedures and compared England with Wales. The four procedures were cataracts, the procedure given the shortest targets first in England, knee replacement – orthopaedic surgery has had large volumes contracted out to independent-sector treatment centres in England – hernias, which are a high-volume routine procedure, and excision of the rectum, a routine but usually urgent procedure.

Waits for cataracts and knee ops fell in both countries, while those for hernias and excision of rectum were relatively flat.

Robinson also looked at those who waited longest, the last 10 per cent, but, again, it was clear that waits in both countries were decreasing at very similar rates.

Wales has not made a large-scale investment, but it has focused on systemic tools such as demand and capacity planning.

The Health Service Journal seems to think that NHS England and new Labour may well have something to learn from NHS Wales and real Labour – and not before time.

Dr Julian Tudor Hart works in retirement as a research fellow at Swansea Medical School and is an active member of Wales Labour Party. In the 1960s, he was a Communist candidate for Parliament and a well-known GP in the mining village of Glyncorrwg.
This article first appeared in the Morning Star (27.3.08)