Lansley Wars: a cautionary tale
If you want to know what a major shake-up of public health services looks like, ask someone in the UK’s National Health Service about the Lansley Wars.
The wholesale reshaping of the NHS about a decade ago – named after then British health secretary and chief architect Andrew Lansley – to promote greater competition, has left deep scars in that most beloved institution to this day.
Those involved – doctors, hospital managers, patient advocates – use the terminology of war to describe those years. They talk about fighting to retain patient services from marauding neighbouring hospitals and new private players, and surviving culls of long-established NHS organisations in the name of savings.
During the wars, Lansley was asked to resign by both the leading nursing and medical organisations in the UK, amid warnings that the reforms would lead to patient deaths. The man was even the subject of an unflattering, and briefly popular, rap song.
A decade or so later, the prevailing view is that whole painful exercise was a costly mistake that needs to be unpicked where it can be and fudged where it can’t. It is difficult to overstate the resources, goodwill, and expertise lost during these years, all of which could have been better used to cut surgical waiting lists or hire more doctors.
That is why it is concerning that elements of the massive New Zealand health system review, released on Tuesday and largely endorsed by the Government, have a whiff of those NHS reforms from a decade ago.
First of all, there are lots of sensible, if not exactly revelatory, recommendations in the review.
We should be providing more healthcare in the community rather than in hospitals; we need services to be less ad hoc, so a patient in Northland gets the same level of care as one in Wellington; and we need good IT systems to give us a better national and local view on what is actually happening in health services.
The focus on improving Ma¯ori health, on which this country continues to have a shameful record, through a new agency, is also a move in the right direction.
But alarm bells ring when the review talks about a new independent Crown entity, Health
NZ. It will essentially oversee district health boards’ operations – that is patient services – with a tighter rein, to allow the Ministry of Health to focus more on policy wonkery and public health.
This is strikingly similar to the creation of NHS England in 2013 to, among many other things, oversee local health services and let the UK Department of Health focus on policy wonkery and public health.
Books have been written on NHS England’s successes and failures, but its creation has been credited with generating more, not less, complexity and confusion in the NHS.
Having a semi-independent agency running national health services hasn’t saved Britain from long surgical waiting lists, massive health inequality, or crammed emergency departments. And that is not mentioning its woeful management of the coronavirus pandemic.
Back in New Zealand, the reduction of district health boards from 20 to between eight and 12, and the cutting of elected officials, seems, on the face of it, sensible.
Some small DHBs have struggled to attract the staff to run effective health services locally, and a lot of DHB board members have little to no expertise in running health services.
But the changes will also be massively disruptive and distracting at a time when focus needs to be on improving services, rather than which group of people runs which service.
The lesson of the NHS is that major health reform is usually harder than initially envisaged, and the benefits, especially the financial ones, are smaller.
Whatever changes are made, let’s make sure New Zealand doesn’t need to spend the next decade trying to undo them, rather than improving healthcare for patients.