2012: what now for the NHS?
What has 2012 got in store for the NHS? Here are HSJ’s predictions for the year ahead.
The Health Bill will pass with most amendments to it proposed by government to head off a make-or-break vote in the Lords. The real action will come in the creation of the regulations detailing the functions of the NHS Commissioning Board, Monitor and the Care Quality Commission. These are – even now – also being shaped by the expected recommendations of the Mid Staffordshire inquiry.
Some believe Andrew Lansley will lose his job as health secretary this year in a mid-term reshuffle. However, since we now have a five-year fixed-term parliament, the cabinet overhaul could well be delayed until early 2013. The odds are that Mr Lansley will finish the year as health secretary.
The NHS will end 2012 reporting a small financial surplus across the system and with waiting times broadly in line with government targets. However, the continuing trend of deteriorating performance in a small, but significant, number of outliers identified in the Department of Health’s quarter 2 report will continue to accelerate. The organisational restructuring proposed as a solution will, as ever, prove more complicated and time consuming than hoped. This will leave some organisations and health economies facing a bleak couple of years.
However, there is some hope that 2012 will bring greater maturity when it comes to closing specific services (as opposed to organisations) which are financially and clinically unsustainable. Chris Calkin draws the link between the two and there appears greater clinical and political backing for necessary change. However, the latter will be at its strongest in 2012 and any proposals left outstanding in 12 months may struggle.
The development of the new commissioning landscape will continue with one defining characteristic – the leveraging of economies of scale. HSJ’s latest, and unique, analysis of emerging clinical commissioning groups suggests there are now around 279, down from 335 in March last year. The proportion of CCGs covering a population of 100,000 or fewer has fallen from 45 to 25 per cent, while those with responsibility for more than 300,00 has nearly tripled to 16 per cent. Expect 2012 to end with fewer than 250 CCGs.
2012 will not see rapid progress made in the privatisation of services. The speedy floating off of commissioning support is not popular with medical interest groups or the leadership of the Commissioning Board. Commissioners have also taken an understandably cautious approach to rolling out any qualified provider. The tortuous process required to secure the Hinchingbrooke franchise for Circle means the experiment is unlikely to be repeated (more than once or twice) any time soon. However, the outsourcing of some support functions will accelerate as the need to deliver efficiency savings builds.
The political controversy engendered by the Health Bill is likely to be replaced by a row over the implementation of the Dilnot reforms. The spring’s social care white paper will also give further momentum to the development of integrated care, as the Future Forum will recommend next week. This week’s DH commissioned report from the King’s Fund and Nuffield Trust suggests integration should be given the same priority as waiting times. In an exclusive opinion piece the leaders of the two think tanks argue integration can be delivered “without legislative change or structural upheaval”. That is true, but as the report makes clear it also requires significant change to culture, incentives and interpretation of policy. This is a tough enough task for an NHS with a clear head, let alone one facing a year with a bewildering range of existing challenges.
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Readers' comments (8)
Roy Lilley | 4-Jan-2012 10:49 am
"the leaders of the two think tanks argue integration can be delivered without legislative change or structural upheaval”. This is true, as can clean services, lower wating times and fairy cakes for tea. The imporant question is why isn't it delivered universally, reliably, everyday? Highlighting good practice is not the same as fixing bad practice. What are the underlying reasons we are talking about the same things this year as last year and the year before. Does the NHS have no memory and do the leaders have no fresh ideas?
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Anonymous | 4-Jan-2012 2:51 pm
...and why isn't Roy Lilley a Government adviser on health matters? Because if he isn't then he damn well should be! Roy is one of the few people that speaks any common sense in regards to health care in this country. Keep on telling them Roy, they'll listen eventually!!!!
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Blair Mcpherson | 4-Jan-2012 3:52 pm
I predict NHS commissioners will make a bid to take responsibility for health and social care for older people. I predict another scandal in the care of people with learning disabilities. I predict a major shake up at the Care Quality Commission but not the one people expect as Hospitals get there own specialist inspection service .I predict whislle blowing on some doggy contracts, dubious commercial deals and the culture of freebies. I predict some chief executives will get their P45s.
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Anonymous | 4-Jan-2012 9:56 pm
i predict a riot.
chiefly made up of the big consultancy firms fighting each other for all the millions of "development" funding that's being thrown attrying to get GPs to become NHS executive managers and NHS managers to become private entrepreneurs.
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Anonymous | 5-Jan-2012 9:45 am
I predict a further deterioration of morale among community services staff as, despite everyone's agreement that much more service delivery should be community-based, the whole of the NHS lurches yet further towards building up huge Acute FTs courting private activity.
I predict that hospital-based consultants will continue to be hospital-based consultants despite most of their services being suitable for moving into the community.
I predict GPs will be so busy carrying out more and more commissioning duties that their patients have to be sent to hospitals to receive the care they would otherwise be able to receive from the GP.
I predict another year of almost total uncertainty, with CCGs not delivering, PCT commissioners continuing to be useless, the Commissioning Board pretending to start working, the CQC continuing to drown in over-responsibility, Osborne demanding his £20bn of flesh regardless of where it comes from, the public crying out against hospital closures reducing local access, and Andrew Lansley continuing to act as La La.
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Anonymous | 5-Jan-2012 12:26 pm
I predict a new Secretary of State to lead us into the promised land (regrettably my predictions rarely come true...sorry!)
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Patrick Newman | 5-Jan-2012 1:11 pm
QIPP is a trojan horse of cuts and privatisation and 2012 we see the political temperature of the NHS debates rising sharply as the cuts surface locally and nationally. Public health will become more 'political' once it comes under the wing of local government. CCG's will continue the inevitable process to re-birth of PCT's with GP's become more detached from their decision making or being GP's.
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Anonymous | 9-Jan-2012 5:30 pm
What about some clear objective setting, without prescriptive targets... if everyone is working towards the same ambition, or set of ambitions, then we could at least see some forward momentum. Why not pick one item, say low waiting times for patients, and agree that it would be beneficial for the health service, the tax payer and the patient to reduce this as far as is possible given clinical constraints? We could see some self motivated teamwork, collaboration, innovation and measurable performance improvement! (as well as reduced costs)
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