2012: what now for the NHS?

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.