Read on Twitter
Right, a little thread on NHS reform.
Last Friday, @HPIAndyCowper got hold of leaked proposals for the government's NHS white paper: http://www.healthpolicyinsight.com/?q=node/1700
BBC coverage: https://www.bbc.co.uk/news/health-55960355
Last Friday, @HPIAndyCowper got hold of leaked proposals for the government's NHS white paper: http://www.healthpolicyinsight.com/?q=node/1700
BBC coverage: https://www.bbc.co.uk/news/health-55960355
There are at least three different things going on in this draft:
(1) Reasserting ministerial control over NHS England
(2) Undoing the competition-only framework of the 2012 Lansley reforms, and legislating to make collaboration easier
(3) Structural reform!
(1) Reasserting ministerial control over NHS England
(2) Undoing the competition-only framework of the 2012 Lansley reforms, and legislating to make collaboration easier
(3) Structural reform!
Let's start with (1):
@NicholasTimmins thinks more ministerial control is a bad idea: https://www.instituteforgovernment.org.uk/blog/leaked-nhs-reforms-would-take-us-back-wrong-sort-future
(parts of pandemic response under more ministerial control than NHS England - T&T and PPE run by DHSC and NHS Supply Chain - weren't successes: https://www.instituteforgovernment.org.uk/blog/prime-minister-plan-radical-shake-nhs-not-right-prescription)
@NicholasTimmins thinks more ministerial control is a bad idea: https://www.instituteforgovernment.org.uk/blog/leaked-nhs-reforms-would-take-us-back-wrong-sort-future
(parts of pandemic response under more ministerial control than NHS England - T&T and PPE run by DHSC and NHS Supply Chain - weren't successes: https://www.instituteforgovernment.org.uk/blog/prime-minister-plan-radical-shake-nhs-not-right-prescription)
. @Davewwest right to point out that this will be politically challenging: https://www.hsj.co.uk/commissioning/hancock-will-face-difficult-questions-over-his-power-grab-to-stop-nhse-games/7029455.article
On (2), this broadly continues last 5-6 years of English national policy initiatives, and makes explicit what had been implicit before
I'm still struggling to get my head around how accountability will work, though
I'm still struggling to get my head around how accountability will work, though
If not choice-and-competition, perhaps more transparency is partly an answer: https://twitter.com/axelheitmueller/status/1357209050270887940
Who's accountable to who within govt matters, but so does the 'sunshine effect' of transparency. See: https://www.instituteforgovernment.org.uk/publications/accountability-modern-government-recommendations (h/t my colleagues @MShepheard and @ben_guerin)
Who's accountable to who within govt matters, but so does the 'sunshine effect' of transparency. See: https://www.instituteforgovernment.org.uk/publications/accountability-modern-government-recommendations (h/t my colleagues @MShepheard and @ben_guerin)
One big risk (as @hughalderwick and co. point out) is that policymakers overestimate benefits of reform
Better-integrated care might improve patient satisfaction but highly unlikely to save money in the short-term: https://www.bmj.com/content/372/bmj.n248.full?ijkey=SH0XNKdcStb60FX&keytype=ref
Better-integrated care might improve patient satisfaction but highly unlikely to save money in the short-term: https://www.bmj.com/content/372/bmj.n248.full?ijkey=SH0XNKdcStb60FX&keytype=ref
(3) is there implicitly.
The draft says the proposals "avoid a disruptive top down reorganisation"...but also propose replacing Clinical Commissioning Groups with Integrated Care Systems:
"We propose that the majority of CCG functions to be exercised by the ICS NHS Board"
The draft says the proposals "avoid a disruptive top down reorganisation"...but also propose replacing Clinical Commissioning Groups with Integrated Care Systems:
"We propose that the majority of CCG functions to be exercised by the ICS NHS Board"
Sorry for the acronym soup - but I tip my hat to anyone who can explain to me how that is not a reorganisation
Another point - structural change may not lead to integration...: https://www.nuffieldtrust.org.uk/news-item/five-traps-to-avoid-in-a-new-round-of-nhs-legislation
(Just ask Northern Ireland's Health and Social Care Trusts on that front: https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/integrated-care-in-northern-ireland-scotland-and-wales-kingsfund-jul13.pdf)
(Just ask Northern Ireland's Health and Social Care Trusts on that front: https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/integrated-care-in-northern-ireland-scotland-and-wales-kingsfund-jul13.pdf)
These are my half-formed opinions (not @instituteforgov's!) - but strikes me that:
- Case for more ministerial control not yet made
- Still need accountability if ditching internal market
- Case for more ministerial control not yet made
- Still need accountability if ditching internal market
