Even though Professor Martin McKee, from the London School of Hygiene and Tropical Medicine, has 25 years of experience in researching health systems, including writing more than 30 books and 500 academic papers, he states in a personal view published on bmj.com today that he still does not understand the government’s plan for the NHS, saying: “I have tried very hard, as have some of my cleverer colleagues, but no matter how hard we try, we always end up concluding that the bill means something quite different from what the secretary of state says it does.”
According to McKee, even Malcolm Grant, the incoming chairman of the National Commissioning Board, has expressed that the bill is “completely unintelligible.”
Professor McKee teaches a course on health systems every year, knowing that his students will also expect him to explain the changes proposed by the Department of Health in England this year. He writes:
“If I am to do so, I need to understand them first.
Here lies the problem.”
He states that his first problem lies in understanding what the changes are trying to solve. Whilst the government claims that a reform is needed due to the NHS’s poor performance in international terms, the evidence it has produced has been completely discredited. For example, in regard to mortality rates caused by heart attacks, independent studies have demonstrated that the UK is now improving at a more rapid rate than nearly any other country. In addition, the Organization for Economic Co-operation and Development (OECD) has claimed that the UK would have performed even better if it had not continually reorganized the NHS.
McKee writes that his second problem lies in trying to understand what is being proposed:
“The prime minister has reassured us that he will not privatize the NHS. Yet the management of one hospital has just been handed over to what is essentially a private equity consortium.”
McKee also tries to figure out the secretary of state’s role. Whilst he reads that the secretary of state will no longer have a direct role in the management of the NHS, he sees “ever more examples, from waiting times to refusals to treatments, where he is actively intervening.”
His third problem lies in understanding why so much is happening now. Whilst the president in the United States is unable to do anything without the approval of Congress, in the UK, the Health and Social Care Bill is already being implemented, although it has not passed as legislation.
In a concluding statement, McKee writes:
“I realize that my bewilderment may simply be a consequence of my own failure to understand the insights that have been granted to wiser and more learned individuals than myself … But I’m also hoping that someone, somewhere, among the BMJ’s extensive and erudite readership, will be able to help me.”
Written by: Petra Rattue