After the 2012 disaster many said “never again,” but fundamental reform must happenby Bob Kerslake / July 26, 2018 / Leave a comment
Much has been written about the funding issues facing the NHS at 70. Much less has been said about reforming NHS structures.
If we want to create an NHS that is truly sustainable for the future, however, we do need to look again at how it is organised. What we have now is palpably not fit for purpose.
The 2010 coalition government quickly established a programme of ambitious reform across pretty much the whole of the public sector. This was in part driven by austerity but also by the pent-up ambitions of ministers achieving office after a long period in opposition. At the same time, David Cameron significantly reduced the capacity at the centre of government to review and scrutinise what was coming forward from departments.
This “fast and furious” approach to reform brought with it significant problems across government, for example the well-publicised difficulties with universal credit. But by far and away the biggest difficulties came in the reforms brought in by the Health and Social Care Act 2012. A fragmented and depleted structure was created that was singularly ill-equipped to meet the future needs of the health service.
By the end of the coalition government there were two prevailing conclusions about the NHS reforms. First, that they had been a missed opportunity at best and a disaster at worst. Second, that the upheaval and general grief caused by the reorganisation meant that there could be no prospect of further organisational change.
The result of this view has meant that subsequent reorganisation has happened by stealth. Some of this change has not been without merit, for example the creation of sustainability and transformation partnerships. Bringing together clinical commissioning groups in some areas has reduced costs. However the overall effect has been piecemeal and lacking in coherence.
What changes might be needed? First, it is important to say that the way the organisations of the NHS have worked has been significantly influenced by the funding crisis. NHS Improvement, for example—notwithstanding the brave vision of its first chair Ed Smith—has become “NHS Containment” or “NHS Enforcement,” acting on behalf of the secretary of state to bear down on provider finance and performance.
“Cameron significantly reduced the capacity to scrutinise what was coming forward from departments”
The most essential task that must be taken first is to “reset” the…