Lansley pledges to cut NHS management costs 'by almost half'

Health secretary Andrew Lansley has told the Conservative party conference that his proposed NHS reforms, based on giving GPs greater power over NHS budgets, will also ensure that providers to the health service offer best value for money. His speech to the conference, which also includes a pledge to cut NHS management costs "by almost half", comes the day after a major report from thinktank Civitas calls for greater involvement on the NHS with private providers. The report criticises what it calls a "closed shop mentality" in the NHS that it says means some patients miss out on better services. The report, Refusing Treatment, examines whether the idea of a market in the NHS is flawed, or whether it has been "stifled" — and finds in favour of the latter. It says that most participants report positive effects where a market has genuinely existed, but it acknowledges that a true market has not been in operation in the NHS, with few services put out to tender. Civitas wants this to change. The report implicitly endorses Lansley's changes, identifying a structural imbalance of power favouring providers, ie hospital trusts, at the expense of purchasers, ie primary care trusts and practice-based commissioners. It also says there is a 14% cost advantage for NHS providers over private and voluntary providers and there are "severe constraints" on the ability of PCTs to tender services effectively, including poor data quality and what it says is the bureaucratic and time-consuming nature of procurement. It also describes what it calls "a deep cultural reverence for the NHS as something more than a health system" which acts as a powerful brake on market incentives and "enables hospital trusts to exert a power force on PCTs tending towards the status quo -often where patients would be better served by the introduction of new services in the community". Last week, doctors' leader warned the government that its planned health reforms could undermine the long-term future of the NHS in England. The British Medical Association said it was not against the whole vision, but had concerns the changes could affect the service's "stability and future". Response to the Civitas report, including from some private providers, has been muted; one group representing private providers said the report was too bleak a picture and that most NHS trusts were cooperating productively with the private sector.