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NHS leaders need freedom and right tools to drive radical changes

NHS leaders must be given the freedom to drive through radical changes to the way care is provided if the health service is to live within its means and deliver quality care in the future, said NHS Confederation chief executive Mike Farrar.

Speaking ahead of the start of the Health Bill debate in the House of Commons today (6 September), Mr Farrar said: "We remain to be convinced that the Government's NHS reforms will deliver a coherent system and enable the health service to tackle the most significant challenges it faces today.

Urgent need for freedom and right tools

"NHS leaders urgently need the freedom and the right tools to drive radical changes and improvements to patient care.

"The way the bill currently stands, there is a risk that the decision making process to change local services is hindered by new structures, taking away the freedom and clarity local decision makers need to drive better care for their patients.

Real danger of paralysis

He said: "There is a real danger that the NHS could find itself in paralysis at the very moment it needs to make key decisions about the sustainability of parts of the NHS."

NHS Confederation briefing for MPs

Our third reading and report stage briefing for MPs says we believe that the NHS does have to change in order to live within its means and meet rising demand while continuing to improve quality and outcomes. But we remain to be convinced that the Government‟s reforms will deliver a coherent system and enable the NHS to tackle the most significant challenges it faces today.


The briefing recommends that:

  • The Government should clarify the powers, roles, relationships, and responsibilities of different organisations in the new structure.
  • The Government should clarify how the reforms will support effective and speedy decision-making.
  • Clarity is needed on how the Government intends clinical senates and clinical networks to work with clinical commissioning groups (CCGs), and what the status of their advice will be.
  • Parliament should seek to place a duty or responsibility on the NHS Commissioning Board to build capacity and capability at a local level so that devolution of power to clinical commissioning groups can take place steadily and safely.
  • The Government should clarify under what circumstances the NHS Commissioning Board will be expected to engage with national and local healthwatch.
  • Parliament should place a duty on the NHS Commissioning Board to publish information about complaints received about its commissioning decisions and to publicise arrangements for how it deals with complaints. There should also be a duty on the Board to set out how it has discharged its responsibilities for involving patients and the public in its commissioning plans and decisions.
  • The Government should develop clear definitions for what is meant by 'choice', 'competition', 'integration' and 'integrated care' in this Bill and to confirm that the proposed reforms will allow for different kinds of integration.
  • Monitor should be tasked with overseeing the development of a national framework for local use in supporting decision making around when each mechanism (competition, integration and choice) will be most effective, and taking action if providers or commissioners operate outside it.
  • Local commissioners should have the freedom to make judgements within this framework and should not be subject to overly detailed, prescriptive guidance.
  • Decisions by bodies including Monitor, CCGs and the NHS Commissioning Board should be defensible using the NHS Constitution as a proxy test for the public interest and should not pursue one method at the expense of the other (i.e. competition and integration approaches should be assumed to be equally legitimate).
  • On tariff, clarity is needed on;
    • what will happen to competition between providers for services which are not on a tarif
    • to ensure that sufficient resources are committed to the development of tariff
  • Clarity is also needed on:
    • the respective roles of commissioners, providers and regulators in respect of quality of care;
    • how the Government intend to ensure that the NHS Commissioning Board and clinical commissioning groups can work together to improve quality in primary care.

Read the briefing for MPs in full.

Failure regime for NHS trusts

The NHS Confederation has also produced a seperate briefing on the Government's proposals regarding a failure regime for NHS trusts. Read the briefing.