Nuffield Trust responds to Future Forum report

Commenting on the report published today by the NHS Future Forum,Nuffield Trust director Dr Jennifer Dixon said: “On balance the report forms a good basis for taking the bill forward. There will be a temptation among some to prolong the debate in the hope of further concessions but the time has come to amend the bill, and move on. Political focus needs to shift urgently to the difficult decisions confronting the NHS. Further uncertainty would likely have a demoralising effect on clinicians and managers, and make the already difficult job of achieving unprecedented efficiency savings even harder.

“It is also important to emphasise that this bill never was and never will be the solution to all the main challenges facing the NHS. Presenting it as such was part of the original problem. To build confidence the Government should over the coming weeks and months also seek to outline a coherent and credible plan for how it intends to deal with the very real risk of operational failure in the places where finances are already weak.

“In that sense the Future Forum’s insistence that the central efficiency drive should take priority is absolutely right. The next four years are going to be extremely challenging for the NHS. Handling this effectively means putting into place measures which will help the health service to make large savings while maintaining access and quality levels. Longer term it is about encouraging the use of whichever arrangements have the best chance of promoting greater quality, efficiency, equity and openness. These are not wholly separate tasks.

“For instance, in a more challenging climate, clear expectations around outcomes and tight and explicit financial controls, with transparent mechanisms for reporting progress will be crucial. The recommendation for consortia and foundation board meetings to be open to public scrutiny, in addition to just being good practice, helps take us closer to this reality. As does the acknowledgement that investment in good management is essential. We are also pleased to see the recommendation that Monitor’s compliance function be extended until Foundation Trust Boards are fully ready to oversee the performance of their respective hospitals.’

Dr Dixon continued: “Finding a way through the highly charged, polarised debates of the past few months was always going to be difficult. The Forum has done a good job of helping to clarify and suggest ways that the best intentions of the original legislation can be built upon, whether in terms of creating more patient choice or establishing the conditions for less political interference and more clinical leadership.

“As a set of principles, the recommendations provide a sound basis for consensus. The question is whether the government’s proposed amendments will speak fully to the Forum’s recommendations. We urge the government to ensure that they do so that the Bill can be passed without further delay.”