Targets under review and NHS legislation open to change - PM

In a speech today, Theresa May also said:

• There would be a clinically led review of NHS “targets”.
• Government would “consider proposals from the NHS for multi-year funding for training places”

In the speech at the Royal Free Hospital in London, she said the government must “learn the lessons of the past and not try to design or impose change”, so the NHS as a whole would be asked to bring forward proposals.

She said she believed parts of the current system and regulatory framework are holding back progress, and the government would “consider any proposals from the NHS on where legislation or current regulation might be creating barriers”.

She added: “And where we feel that action is required we will look to build the broadest possible consensus in parliament – so we truly create an environment in which the NHS can get on with delivering the long-term plan.”

It had been widely thought in NHS circles that any legislative change during the current parliament was unlikely, although the Conservative party’s manifesto in 2016 included a similar policy.

Many in the sector have called for legal change to steer away from the internal market - which is designed to encourage providers to compete for patients and to be paid according to activity volumes - towards rules which encourage integration and collaboration.

Ms May’s comments also represent a clear admission that mistakes were made in the Lansley reforms of 2012, for example in the “bureaucracy” created.

Ms May added: “The intentions behind the creation of the internal market in the early 1990s were right.

“It is right that those commissioning health services should be close to the populations they serve. They understand the specific needs of the people in their area – and they can choose the providers and services that best meet those needs.

“It is also right that the best providers should have greater autonomy than those that are struggling. This drives innovation in care that would otherwise not happen.

“But I believe that, as our NHS evolves, and delivers more joined up care across different services, we should make sure the regulatory framework keeps in step and does not become a barrier to progress.

“So I think it is a problem that a typical NHS clinical commissioning group negotiates and monitors over 200 different legal contracts with other, different, parts of the NHS.

“It is too bureaucratic, inhibits joined up care, and takes money and people away from the front line.

“So where legislation is making it harder for professionals from different parts of the NHS and different local authorities to work together – we should be prepared to change it.

“Where it is resulting in overly bureaucratic processes – we should be prepared to change it.

“And where it is making it harder to hold NHS leaders accountable for delivering better outcomes for people – we should be prepared to change it.”

She said proposals could be put forward as the NHS develops details of the long-term plan over coming months, and that “any legislative proposals should be led by the health and care community, as recommended by the [Commons] health and social care select committee”.

“We must learn the lessons of the past and not try to design or impose change from Whitehall.”

In relation to targets she said: “As the NHS develops the priorities and outcomes the long-term plan will deliver, we would like clinicians to confirm the NHS is focused on the right targets - for both physical and mental health - which incentivise the best care and outcomes for patients, and have the broad support of our health professionals.”