NHS reforms: equity and efficiency at no extra cost

Greetings readers,

How are we today? Looks like the weather has improved for the weekend. Nice. Well, from the picture above you will most probably have concluded that this will be a successive post about the NHS. Yes, I'm sure I can hear an audible groan. But wait! This is going to be a positive post based on some very encouraging research recently published by the LSE and Dr Foster Intelligence, a public-private partnership that aims to improve the quality and efficiency of health and social care through better use of information. My kind of organisation.

According to the LSE press release, a team of researchers led by Zack Cooper and Julian Le Grand (great name) retrospectively examined changes in waiting times for patients undergoing three key elective procedures in England between 1997 and 2007 (hip replacement, knee replacement and cataract repair). They then analysed the distribution of those changes between socioeconomic groups. The findings are published in BMJ.com.

In 1997, those from more deprived areas waited longer for treatment than those from more affluent areas. But, by 2007, this phenomenon had disappeared. In fact, in some cases, patients from more deprived areas were waiting less time than patients from more affluent areas. Furthermore, in 1997, the poorest fifth of the country waited more than 3 weeks longer for a hip replacement than the wealthiest fifth. In 2007, the least advantaged got a knee replacement at exactly the same time as the wealthy.

So it seems as though the government's introduction of market-based reforms including patient choice and provider competition has not led to a rise in inequality for the least well-off patients. Far from this, it appears that there is real equity between the poorest and richest with regards to NHS waiting times. We should surely take this as a very positive sign that the government is doing something very right. Pat on the back for you, just this once.

Interestingly however, the LSE press release concludes that the research findings "cannot prove what policy mechanisms led to reductions in waiting times and improvements in equity". So either a complex and detailed piece of research needs to be commissioned to identify and delineate just what these mechanisms are, or we just accept the fact that things are improving in the NHS, and hope they continue to do so. The blind leading the blind perhaps?

Zack and Julian have also written an interesting and rather more political piece in the comments section of the Guardian online. In it, they describe how the NHS is improving on almost every indicator of quality; productivity is up, waiting times are down and patient satisfaction is at an all-time high. However, they partially dismiss these improved indicators as merely a function of increased spending, but to something more complex, linked to the government's recent market-led NHS reforms. Indeed, the argument seems to distance itself from McKinsey's recent proposal to cut the number of NHS jobs by 10% in order to increase efficiency.

The salient point here is that it is possible to reduce NHS spending without compromising the quality of health outcomes or the equitable distribution of care. This reminds me of the Time article I read whilst in the States earlier this year, citing the Mayo Clinic, as an examplar to be studied and followed. Indeed, as Zack and Julian both allude to, it will be interesting to see what further reforms will be implemented by the next political party in power. Whichever one it is, I sincerely hope that they have been paying attention to the encouraging research and indicators that show that 60 years on, the NHS is still doing its job, and doing it well.

Currently listening to "Saturdays= Youth" by M83, and in particular, "Couleurs". Synth-pop doesn't get much more epic than this. Incroyable....

Thank you for reading,

F.