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
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
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