It would be wise not to underestimate the government’s commitment to radical NHS reform.
Health secretary Andrew Lansley has ambitious plans for the NHS and this means there will be challenging times ahead.
There are plenty of emotions generated in the hearts of public servants by the election of a new government. Anticipation and excitement compete with anxiety and even fear. After years of certainties, job security, funding, structure and all the pieces of the jigsaw that make up our lives and careers are up for debate.
Of course, while many leaders in the NHS are genuinely concerned about what the future holds under the new Liberal-Conservative coalition, there is an assumption that reforms tend to result in changes to the way structures look, the names on doors and some of the activities, but that the system carries on and, in particular, the location of power and accountability remains unchanged.
I think this underestimates just how radical Mr Lansley intends to be. There is clearly a genuine appetite for change, and a tangible and long term programme to achieve it. I have little doubt the health secretary’s programme has the potential to radically alter the way the NHS is run, funded and held accountable and the NHS needs to engage with it on that basis.
In the short term, there is still a need for substantial efficiency savings. The promise from government about the level of funding that the health system can expect to receive will provide some reassurance. But this protection increases the expectation of performance. I suspect that the problems in other parts of the public sector will increase the call made on NHS resources.
In the medium and long term, there is a new NHS board, new roles for the regulators, a new commissioning responsibility for GPs, promises of an information revolution to provide more detail than ever before to patients, and a move towards “value based pricing”, for the National Institute for Health and Clinical Excellence. This is where the plan becomes very radical.
There is a genuinely ambitious attempt to recast the relationship between the NHS and patients, combined with bold decisions to place GPs at the heart of commissioning decisions, while at the same time removing political interference in the system by establishing an independent board. Only when we know the final shape and remit of the board will we really know whether Mr Lansley will manage to create sufficient distance for himself from the difficult and unpopular decisions the board may have to take. But what is clear is that if the project succeeds it turns where power is located in the NHS almost on its head.
However you view the move, it has real implications for the whole service. The strategic health authorities will be closed down in 2012, their decision making functions taken on by the board and its regional offices. Primary care trusts will carry on in some form, mainly with responsibility for public health and possibly commissioning specialist services, but they may also find themselves competing for work from groups of newly empowered commissioning GPs.
For providers there will be much more independence and, as Audit Commission chief executive Steve Bundred commented recently, they might be taken off the state balance sheet. The familiar model of strategic planning will give way to market based mechanisms. Real competition law and increased competition will become a fact of life. Other changes coming with this, including greater transparency, more payment by results and new measures of success, will be equally challenging.
Any number of questions remain unanswered about how this approach to commissioning and providing healthcare will work. How will money be allocated? How will GP groups be held to account? Are outcome measures enough to hold on to the improvements that targets produced? There are many more. Negotiations must be had about a new GP contract, about the scope and powers of an independent board, and some very significant changes in the regulatory machinery, including big shifts in the role of Monitor and the Care Quality Commission. And of course old fashioned political instability could throw a spanner in the works in any number of previously unforeseen ways.
What is certain, however, is that there is more to this package of measures than simple chair arranging. Whatever the old hands may tell you, a genuine attempt is being made to recast the way our health service works and the relationships people have with it.
Unlike previous reforms, we are likely to be shown most of the framework in one go rather than over several years. While this will provide the basic architecture, hopefully there will be more scope for local innovation, adaptation and initiative to ensure the best results for patients are achieved.
We have a challenging course ahead of us that will require courage and imagination to navigate. Lansley is serious about his programme for change and everyone in the NHS will need to think hard and seriously about what that means for them and the work they do.
- Acute care
- Andrew Lansley
- Audit Commission
- Board Talk/governance/assurance
- Care Quality Commission (CQC)
- Change management
- Competition and co-operation
- Conservative policy
- GP commissioning/practice based commissioning (PBC)
- Lib Dem-Tory coalition
- Payment by results (PbR)
- Primary care
- Public health
- Service design
- Strategic health authorities (SHAs)