The reality of Britain’s reforms of its National Health Service

By Donald W. Light
The New York Times’ recent upbeat editorial about the radical reform of Britain’s National Health Service (“Health Care Reform, British Style,” Aug. 4) has its facts wrong and biases showing. As anyone familiar with the NHS knows, it has not been “bristling at any suggestion of change” but rather has been absorbing large waves of change since 1990.
The new government’s reforms will eliminate layers of public bureaucracy piled on by the last two Labour governments, but only to install a new variation of commissioning that will require more private bureaucracy in the form of hired management companies. These companies will charge several times more for doing the same kind of paperwork and administration that the civil servants who are being laid off currently do.
Or perhaps the private management companies will hire back the laid-off men and women who, after all, know how things work, only now the workers will have no job security. There is plenty of precedent for this kind of scenario.
English primary care doctors have long had power over treatment decisions and referrals. To say the reforms will give them more power is misleading, especially since the reforms will now make those doctors responsible for contracting all hospital and specialty services. Everyone agrees this is a time-consuming, complex job for which doctors have no training or experience. If anything, the reforms will add a great bureaucratic burden on GPs so they have less time to provide personalized care to their patients.
The editorial suggests there is cause for worry that introducing for-profit management companies and American features will lead to patients’ interests being shortchanged. Then why endorse such a path? Indeed, overall administrative costs are likely to go up, and 500 little GP contracting groups will not have the clout to save money by reducing the waste built into the hospital-centered structure of specialty services.
In the zero-sum game of a fixed budget with more of it going to management contracts, services to less-affluent patients will have to be cut. Clinical and class inequalities are likely to increase. When, in the name of austerity, the NHS is called upon to save 20 percent of its budget, the new reforms will transfer more money to managed care corporations and leave less for patient care. In these ways, the NHS will become more American.
Donald W. Light
Princeton, N.J.
Donald W. Light is Lokey Visiting Professor at Stanford University and professor of comparative health care systems, University of Medicine and Dentistry of New Jersey. He is the editor of the just-published book titled “The Risk of Prescription Drugs” from Columbia University Press.