System changes & impact on the
NHS
Nigel Edwards
John
Reform on one page
Commissioning – Fragmented
Providers – more autonomous & plural
Regulation – confused
Change drivers – competition, choice, integration
and direction
Secretary of State – in theory taken out of day to
day issues
Rules of the new system – not clear yet
New landscape.....
New
organisations/bodies
The Mandate
NTDA
NHS Trust
Development
Authority
112 Trusts FT
Pipeline
(Jan 2012)
CSS
What does it all mean?
Uncertainty
Accountability – who is really responsible for
what
Decision making
– Competition & mergers
– Procurement
Strategy
No strategy function
Many different actors
A more local focus
Agreement &
implementation harder
Strategy & the wider system
Issues about the size of some CCGs in relation to
the wider system
Federated arrangements are not present in many
places and are hard to make work
Signs of the strategy gap being filled
NHS England will develop a strategy
– Seven work streams
– Rationalisation of tertiary care
– New offer from primary care
– New financial regime
Bill McCarthy talking about regional planning
Will AHSNs do some of this?
But, still more pressures to change
Commissioning guidance
A focus on quality
– E.g. Signs that NHS England will be pushing
24/7 consistency
This has particular implications for out of hours
surgery
Known unknowns - Behaviour
The intention was to break the system and
change the culture – did enough get broken?
How will the people in the new bits of machinery
actually behave?
What will happen when things start to unravel?
Do the players understand the new architecture &
behave accordingly?
Changes in primary care
Worrying situation on demand and workforce
A possibly unanticipated change also driven by static
GMS funding is a realisation that primary care needs
to change too
More federated arrangements emerging
New contracts
Arrangements for out of hours likely to change
Integration
Much enthusiasm for this but it is hard to do
Part of the problem is complexity and overlap created
by multiple initiatives and projects
There are big opportunities but it is harder to do than
it first appears
Procurement and payment mechanisms are an issue
It costs before it pays
Concerns
Financial situation in health and particularly social
care
Plans to deal with this are not very convincing
A significant number of organisations in difficulty
No very clear way forward for the trusts that will
not make FT status
On the upside
New ideas and commissioners with a clinical
focus
A shift to commissioning on outcomes rather than
input and process (I hope)
Health and Wellbeing Boards
A strong consensus that change is required
Questions and discussion
n.edwards@kingsfund.org.uk