System changes & impact on the NHS Nigel Edwards John.
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System changes & impact on the NHS Nigel Edwards John
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Transcript of System changes & impact on the NHS Nigel Edwards John.
System changes & impact on the NHS
Nigel Edwards
John
Reform on one page
Commissioning – FragmentedProviders – more autonomous & pluralRegulation – confusedChange drivers – competition, choice, integration and directionSecretary of State – in theory taken out of day to day issuesRules of the new system – not clear yet
New landscape.....
NTDANHS Trust
Development Authority
112 Trusts FT Pipeline
(Jan 2012)
New organisations/bodies
CSS
The Mandate
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 focusAgreement & 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 consistencyThis 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
