Responding to the Health and Social Care Committee’s report on proposed legislative changes in the NHS, Niall Dickson, chief executive of the NHS Confederation, which represents organisations across the healthcare sector, said:
“There is no appetite for another top down reorganisation in the NHS at the moment – that may be needed down the line but front-line leaders and staff have enough to do without such a distraction. But as the Committee rightly recognises, we do need some targeted changes in the legislation to help staff deliver improvements in patient care and also because we have run out of workarounds. These are a sensible set of proposals.
“Our big worry in the NHS England/Improvement proposals was what looked like a move to greater centralisation – even if that isn’t the intention. We all want local NHS organisations to work more collaboratively but that will not happen by stripping away local autonomy and giving more powers to the centre.
“And while we support the Committee’s view that NHS England/Improvement should come together under a single national leadership, we share its concerns that the centre could become too powerful. That’s why we are pleased the MPs agree that the centre should not start to direct mergers, acquisitions and the capital spending limits of foundation trusts.
“Finally, this is difficult to resolve but the Committee’s proposals do not deal with the ambiguity and tension that will remain in the system when it comes to the governance and accountability of local NHS organisations. Both trusts and CCGs will face tension between the hard accountability they face to their governing bodies under the current arrangements, and their new responsibilities which will require them to play a more involved role in their local systems.
“But we need to be realistic about how much legislative can achieve and indeed whether it is achievable. Our members have consistently told us that their ability to deliver greater collaboration will be down to relationships and leadership – and you cannot legislate for either of those.”