The latest round of NHS reforms, which took effect at midnight, have been greeted with unease and concern about what they could mean for the future of the health service.
Mike Farrar, the chief executive of the NHS Confederation, which, as a management organisation might be expected to flag the more positive aspects of the changes, instead warned of the challenges ahead.
“We need to recognise the huge challenges facing the health service,” he said. “New structures alone won’t enable us to tackle these changes, and we should not see them as a silver bullet.”
Farrar cited, in particular, the need for the NHS to rebuild public confidence in the wake of the Mid Staffordshire NHS Foundation Trust scandal and to deliver on the ‘Nicholson challenge’ to save £20 billion over five years, to bridge a gap between flat funding and rising demand without cutting quality.
Critics of the changes triggered by the ‘Liberating the NHS’ white paper that was published back in July 2010, were less guarded.
Unison, which led the campaign against the reforms as they passed through Parliament in the form of the Health and Social Care Bill, said the cost of the changes was particularly scandalous, given the bigger challenges that the NHS faces.
It claimed: “The cost of the reforms have spiralled out of control, with experts predicting that the total cost could top £3 billion. Together with the demand for £20 billion of so-called efficiency savings, these costs are piling the pressure onto health budgets.”
The union added that the changes had taken a big toll in terms of lost jobs and expertise, as the reorganisation of the NHS has been accompanied by demands for management savings.
But it warned that the biggest threat to the NHS now lay in the government’s commitment to open up more support and provider services to the private sector.
“Even more precious funds will be leached out of the NHS by the growing involvement of private providers, whose primary duty is to make profits for their shareholders, not to provide the very best care for patients,” it said.
The ‘Liberating the NHS’ white paper laid out changes to both the NHS’ planning and purchasing organisations and its provider side.
The changes that finally took effect at midnight slim down the Department of Health, create a new NHS Commissioning Board – called NHS England – in Leeds, abolish strategic health authorities and primary care trusts, and create 212 clinical commissioning groups.
On the IT front, they also abolish the remains of NHS Connecting for Health, which ran the National Programme for IT in the NHS and other national services, and pass its roles to NHS England and the NHS Information Centre – now called the Health and Social Care Information Centre.
They also create 19 commissioning support units to provide finance, HR, IT and information support to CCGs. Somewhat surprisingly, the Department of Health and NHS England did not issue statements to mark midnight’s changes.
However, the acting chief executive of the HSCIC, Alan Perkins, issued one of the more positive responses, saying it was “committed to unlocking the full potential to improve patient care, from delivering high quality data analysis to implementing advanced informatics solutions.”
Policy experts interviewed by the Nuffield Trust said that whatever the impact of the latest changes, the NHS needed time to adjust to them.
Its director of policy, Judith Smith, said: “The biggest challenge is to NHS England and the Department of Health, which have to persuade ministers to reorganise the NHS every few years.
“There is no time for further reorganisation – scarce management talent has to be focused on assuring safe and affordable NHS care.”
A fuller account of the changes and their impact on NHS IT is published in the Insight feature, All change, please.