Despite record investment, NHS performance on efficiency, quality and equity has "floundered" over the last 10 years, according to a damning new report.
The report – Why the NHS is the sick man of Europe – from the independent thinktank Civitas – says "huge funding gaps" remain in the NHS, despite public spending approaching £100bn and an expected surplus of £1.8bn.
It says health inequalities have widened under the Labour government, with a gap in life expectancy between the most and least deprived areas in England of nearly 10 years (for men).
The Civitas report attributes funding gaps largely to "spiralling inefficiency" – it cites the Audit Commission's assessment last year that 31% of NHS bodies failed to meet even minimum requirements on use of resources.
It argues that the solution is putting money in the hands of patients to take control of their healthcare and to empower clinicians once more.
The Civitas report says: "The NHS's problems are systemic. The determination of the government … to control the purse strings is ripping the heart out of the medical profession.
"Senior doctors and senior nurses are forced to spend so much time trying to second-guess where the politicians will turn next, what their budgets will be next year, what the rules allow them to do – not to mention the inevitable targets, top-down pressures, diktat and bullying that comes from the government and its enforcers in the Department of Health (DH) – that they are inevitably prevented from focusing where they want to: on the patient."
Examples given of such top-down interference includes the NHS operating framework for 2008/09, reconfiguration of PCTs by the DH just three years after they were established, and new initiatives "imposed without even consulting doctors".
The NHS was compared unfavourably with health systems in France, Germany and the Netherlands – "The major difference between the NHS and these health systems is that the state is not cast as either the main funder or provider of healthcare, but effective regulator", says the report.
In these European countries, it argues, "the consumer – the patient – controls the purse strings, not the government and the health service is much more responsive."
James Gubb, Director of the Health Unit at Civitas, said: "It is time for the NHS to be progressive; to put money in the hands of patients; and, above all, to empower health professionals to do their jobs.
"While the NHS frantically tries to provide universal healthcare through a centralised, monopolistic and heavily politicised system, the best European systems achieve this very same ideal from doing exactly the reverse, producing much better outcomes and more equity to boot."
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