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NHS Confederation - Proposed way forward for NHS reforms

A new NHS Confederation paper analyses concerns raised about the proposed NHS reforms and suggests measures the Government could take to address them.
 

Where next for NHS reform? is designed to start a conversation about practical solutions to the concerns that will help the NHS manage the significant risks involved. There are four broad areas where concerns have been raised during the debate over the health reforms:  

  • the extension of competition and fears that this will lead to privatisation of provision and fragmentation of services.
  • the shifting of responsibility for commissioning of healthcare to GP commissioning consortia and fears that this goes beyond their capability and capacity and leaves them with serious conflicts of interest. There are also concerns that use of independent sector support for commissioning means the privatisation of commissioning.
  • the arrangements for accountability for decision making in the new system and fears that they are inadequate and insufficiently democratic.
  • the risks in the transition and fears that these are too great, particularly at a time when the NHS faces an enormous challenge in delivering £20 billion productivity gains over the next four years in light of reduced levels of financial growth.

Hard questions

Nigel Edwards, NHS Confederation acting chief executive, said: “The Government has got to ask itself some hard questions about how it manages the reforms from here on in. We are not saying we have all the answers but we do want to start a conversation about the solutions.   

Destabilising

"The debate on the reforms has become very polarised and entrenched, with little movement on the practical ways of managing what are very significant risks. This is destabilising for an NHS that is already making structural changes to meet the Government’s agenda.   

"There is a recurring theme running through our analysis. We have often found a reality gap between ideas that are good in principle and the details of practical delivery, which have often looked opaque or too optimistic.” 

Suggested answers to key questions

  • The paper suggests answers to some of the key questions raised during the debate about competition along with outlining ways forward on the integration of complex care, price competition, any willing provider and the role of the new economic regulator Monitor.
  • On GP commissioning it looks at the concerns that have been raised and suggests solutions to help ensure GPs are fully engaged with the new system. It looks at how to ensure GPs have access to commissioning support as well as considering how accountability can be built into the system and conflicts of interest avoided.
  • On the issue of accountability the paper considers the best way to ensure local politicians and public groups are able to hold consortia to account and seeks to find solutions for issues of governance and the transparency of decision making.
  • And on the transition, the paper says the Government should consider being less directive in terms of its timetable for implementation and allow local flexibilities about how and when reforms are put in place.
  • It says there is a real need to take important decisions on re-configuration now rather than later and suggests ways forward for government communications on the reforms. 

 

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