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Service sweats over plans B, C and D as pause takes its toll

The NHS is paying a heavy, although largely unseen, price for the “pause” in the government’s health reforms.

The first half of 2011 is a crucial period for the NHS. Both providers and commissioners are beginning to feel the full impact of new cost constraints and are working out how to respond. The disruption caused by the reforms was damaging enough to the ferociously difficult decisions that need to be made, like those on pay that HSJ reports on this week. But now we have the prospect of further change, and the reality of further uncertainty.

At the Department of Health’s Richmond House HQ and in NHS organisations across the country, the ever dwindling ranks of managers are devoting increasing amounts of time to developing plans B, C and D. How far and fast will commissioning move to GPs, what will be the competitive environment for providers? These issues and others are the subject of time consuming “scenario planning”.

Politicians might believe they should wait for the outcome of their deliberations, but managers – as good public servants – will say they need to plan for all eventualities.

The government needs to make an unambiguous statement explaining exactly what parts of the reforms will be driven through regardless – and what specifically is subject to the listening exercise. They then need to make it clear how they will deal with the recommendations of the Future Forum and, crucially, by when.

Then it is up to the opposition forces to make their own judgement. The prospect of a year of wrangling as the bill drags through Parliament would place an intolerable burden on the service’s ability to plan effectively.

The NHS will always be a political football, but politicians need to be very mindful of the kicking that it is currently taking.

Readers' comments (4)

  • Has there ever been a period of such destructive mid-reorganisation drift in the NHS previously?

    In my experience never have things been so woolly and dysfunctional for so long.

    I've only been here for a decade. This is only my third big reorganisation.

    Any views from those who've been here longer? Tell us all when it was. Give us some historical perspective.

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  • I have been working in and around the NHS since 1978. I have lost count of the reorganisations which I have experienced. But never has there been such lack of clarity, such lack of value of managerial contribution and such fogginess regarding the destination of travel. I have often reflected that if we were able to calculate the person hours/days/weeks/months/years which we have devoted to reorganisations over the years and spend that time instead on developing quality services we could have avoided some of the unhappiest moments of NHS recent history. Before last year's election it appeared that Mr Lansley thought so too ... how wrong one can least I have the small satisfaction that I didn't vote for him or his party!!!

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  • Re-organisations are very similar to jigsaw puzzles. The strategy is easy, its the picture on top of the box. However when it comes to the 'rollout'' it''s really difficult because you have to make all the pieces fit together. At the moment it's beginning to look like Mr. Lansley may find the only way of getting the pieces to fit is by getting his scissors out!

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  • it looks we and like the n h s is going back to the 1930s
    dennis shaw doncaster

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