Thread on #NHSWhitePaper - As @MattHancock hurriedly brings forward announcement of plans to reform the NHS in England what should we be looking for ? Here are my four key tests.

1. Will change mean greater accountability for workforce planning & development ? People are the greatest asset of the system and also the biggest challenge. Massive vacancy rates, growth in demand, systematic inequality and a need for respite post Covid need addressing.

At present there is no clear line of accountability for workforce. Local services actually employ people, but Sub regional fora have a role as do @NHSEngland but also @NHS_HealthEdEng so ministers and whole agencies can pass the buck and fail to address the challenges.

2. Will the change stop the NHS “playing shops”? The key element of the last NHS reorganisation was the imposition of an internal market and competition. This has led to multiple failings; competition rules preventing local service redesign is top of NHS bosses minds perhaps.

But there are other issues here to address. Too often the hard boundaries between NHS bodies gets in the way of doing what is right for patients. Investing in improvements p, including those which would save money overall, does not happen because the wrong body holds the budget.

Collaboration can be halted by budget parochialism. If 3 physio services want to share rotations one trust might want to charge the others a fee for involvement for example. If change can refocus on population need, not individual budgets that will be a big step forward.

The ending of tendering would be a major step forward. In some areas it has resulted in overly complicated service provision eg seven different MSK providers with different pathways in one area. Again a population health perspective based on collaboration would be better.

The changes are unlikely to prevent sub contracting to the not for profit or private sector, but are likely to make this a more deliberate decisions where speciation support or capacity is needed, not the result of a cost driven tendering exercise.

3. Will the changes help collaboration and integration between health and social care? In some ways this is the most difficult challenge. Giving the bodies where the NHS and council formally collaborate proper legal standing is desirable.

But a legal basis for ICSs won’t address the most fundamental barrier to better integration which is the NHS and social care being funded and based on a totally different basis. Whilst care is a rationed and users pay integration is problematic.

4. Will change open up decision making locally ? National accountability through ministers to Parliament is one thing, but in a system where local decisions are arguably more immediately important for patients and staff, will change open up local decision making bodies ?

From patients, to local community representatives to staff there are a range of stakeholders who feel removed form the decisions that affect them. This is a chance to address this. Include provision for AHP leaders to be at the table, and create directors responsible for rehab.

Commit to social partnership arrangements at all levels and give a real voice to unions and professional bodies in regional and local workforce planning. Make patient engagement more than window dressing.

In reality much of the key local dimension may not be covered by detailed legislation but this is a key time to secure commitments from ministers, @NHSEngland and others that part of the reform will be to improve patient and staff engagement.

Many people have questioned the timing of change and whether staff and stakeholders want more change. For years @thecsp argued that constant reorganisation was disruptive whilst also highlighting the failings of the current system.

Implemented well, proposed changes need not be too disruptive. They way well, in time, lead to changes at service level but at least initially they would largely affect national and regional bodies and CCGs, rather than frontline services.