NHS reforms vital for improving patient care but ministers must resist temptation to centralise the NHS further


Commenting in response to the government’s NHS White paper that has been published today, NHS Confederation chief executive Danny Mortimer said:

“These are the most important set of reforms the NHS has had in a decade. The reality is that the 2012 reforms have largely failed and changes are needed. The reforms will help unlock some of the barriers front-line services face when trying to join up care for the public. The future of health and care must now be based on collaboration and partnership working – these reforms will provide the necessary updates to legislation to make this happen.

“The NHS traditionally fears disruptive reorganisations. But this time round there is much support for these reforms given they will boost efforts to integrate patient care. The use of competition and outsourcing as the main tools to improve quality of care and value for money for taxpayers will be replaced by collaboration and partnership working. This is what leaders across the NHS want. But that doesn’t mean we should end up with local monopolies as we must continue to work effectively, as we now do, with independent and voluntary sector providers.”

Enhanced powers of direction for the government

Danny Mortimer said: “Given the NHS is a public service that costs more than £100bn to run, it is only right to have appropriate accountability to government and parliament. But one of the few successes of the 2012 reforms has been establishing a statutorily independent board – NHS England – to distance politicians from the day-to-day running of the NHS. This hasn’t stopped Ministers from being active in setting policy over the last decade. But it has provided greater autonomy to the NHS and allowed the service to quietly get on with making a series of changes that have improved care for patients.

“The government will need to be cautious here. There will be lessons to learn from the pandemic – for government and the NHS – but it would be wrong to conclude that greater ministerial control would have led to an improved response. The NHS is already one of the most centralised health systems in the world and ministers must resist the temptation to centralise it further.

“Regardless of the accountability arrangements at a national level, the reforms need to empower local NHS and care leaders to lead as part of a new approach to regulation and oversight. They are best placed to run health and care services for their local communities, while continuing to be held to account by parliament.”

Integrated care systems

Commenting on the plans to create statutory integrated care systems, Lou Patten, CEO of NHS Clinical Commissioners and NHS Confederation ICS Lead:

“It is the logical next step to establish integrated care systems as statutory bodies and build on the progress that has been made in recent years bringing together service provision, strategic commissioning and clinical leaders, all of whom will have an obligation to collaborate to improve the health of the communities they serve.

“These reforms will take this further and ensure there is stronger integration within the NHS and between the NHS and local government. This will support place-based joint working to help address the wider determinants of health, support people to live healthier lives and to improve value to the taxpayer. It’s pleasing to see that the reforms will ensure the new statutory bodies are about much more than the NHS.

“Clinical commissioners agree that moving to a more integrated model is the right direction for the NHS; we can see that many of our member recommendations are in the government’s paper. However, the current proposals could lead to the loss of huge amounts of senior staff experience and the expertise of our current clinical leaders, at a time when current CCG expertise must be retained to establish the bedrock of ICS commissioning. This must be addressed or we risk a lot of upheaval for little gain.

“There is a lot more detail to work through in the months to come before we see the draft legislation, not least in terms of how the government intends to ensure there is local flexibility for integrated care systems to determine their own governance arrangements while ensuring we avoid any confusion in accountability. Given there will be a statutory NHS board for integrated care systems, working alongside a wider Health and Care Partnership Board involving local government, we’ll need to ensure there is clarity between the roles and responsibilities of both boards.”

Primary care

Ruth Rankine, director of the NHS Confederation’s PCN Network, said:

“Primary care must have a strong voice at a system and place level, so we are pleased to see the proposals recognising the sector’s importance by ensuring there is a mandatory place on ICS boards. The recognition that one size does not fit all and the flexibility of local systems to design their own governance arrangements is also welcome. This will allow them to better shape their organisations and services to meet the needs of their populations and reduce health inequalities.

“While there is a need for a strong primary care voice at this level, clinical directors of primary care networks cannot achieve this on top of their existing commitments without being resourced properly. That means making the increased funding available for clinical directors working on COVID-19 a permanent resource to enable them to play an effective role in place and system-level discussions, planning and delivery of services.

“We would also expect some of the current funding from clinical commissioning groups that is in place to support PCNs to be transferred into the PCN budget to support effective management and administration.

“As the PCN Network we will work with our members to ensure they are in a good position to take part in these discussions at local and national level.”

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