The NHS risks wasting two years on the “sport of restructuring” instead of improving efficiency, senior figures have warned.
Department of Health guidelines published last week give primary care trusts eight weeks to agree the future of their community services and 12 months after that to complete implementation, as revealed by HSJ.
We have got to find organisational forms which actually help the transformation of community services in the long term, not just go for a quick fix solution
The guidelines, Transforming Community Services: the assurance and approvals process for PCT-provided community services, set out the most likely options as integration with an acute or mental health provider, integration with another community provider or becoming a social enterprise - although the tight timescale appears to rule out the last option for most.
There are also concerns the timescale will result in badly planned mergers and distract from the service change needed to prepare for investment cuts.
Incoming King’s Fund chief executive Chris Ham welcomed the growing interest in vertical integration, but told HSJ “another big restructuring” came with “great risk”.
Professor Ham said: “Frankly, top managers won’t have any time to think about how services are being delivered because they will be going through another round of musical chairs.”
NHS Confederation policy director Nigel Edwards warned the timetable could divert organisations into the “sport of restructuring” and reflected “some very, very sloppy thinking”.
Some mergers might succeed, but would often put badly matched services together, and exclude opportunities like working with social care, he said.
But foundation trusts say they would be able to reduce overall management and back office costs, and have a strong incentive to reduce admissions, if they take over community services.
County Durham and Darlington Foundation Trust chief executive Stephen Eames supported rapid change, “so the focus can be on improving quality and achieving an unprecedented shift of care from hospital”.
Some areas are looking at moving from payment by results contracting to paying a lump sum for unscheduled care, largely regardless of the number of patients treated.
Rotherham Foundation Trust chief executive Brian James said it would “incentivise providers to find the lowest cost way of delivering such services, which for many patients may well be in the community”.
But Mr James warned against merging services with provider trusts which are already financially failing.
Primary and community care organisations have also criticised the new guidance.
NHS Alliance chief executive Mike Sobanja said the guidance was not “one size fits all policy”, and warned strategic health authorities and others should not interpret it that way.
“We have got to find organisational forms which actually help the transformation of community services in the long term, not just go for a quick fix solution,” he said.
The National Association of Primary Care said the 31 March deadline for agreement of plans was “likely to result in a default wholesale shift of community services to acute trusts, which NAPC regards as a retrograde step”.
Chair Johnny Marshall said: “My fear is that as a result of this very important document, acute providers taking on community services will result in the ossification of existing pathways of care at a time when primary care leadership is seeking to transform health services supporting the prevention of unwarranted acute admissions and reductions in length of stay through the investment in high quality community services.
“This will lead to an increase in costs and a diminution of quality, at a time when the service, nationally, is faced with the dual challenge of driving up productivity, while simultaneously improving patient care.
“NAPC will support its members if they wish to contest any local decisions against the criteria set out within the guidance through the cooperation and competition panel.”