Getty
Analysis
Report states that NHS reforms have led to fractured leadership King’s Fund review criticises coalition government for complex, ineffective reorganisation, writes Nick Triggle THE GOVERNMENT’S health reforms in England have been ‘damaging and distracting’, according to a review by the King’s Fund. The report, titled The NHS Under the Coalition Government, is critical of the decision to implement what it describes as ‘complex organisational changes’ when the NHS should have focused on dealing with growing demand and an unprecedented funding squeeze. The 82-page review states that the decision has led to a ‘strategic vacuum’ where there should be leadership and calls the whole process a ‘strategic error’. The King’s Fund says that: ■■ An unwieldy structure has emerged, with leadership fractured between several national bodies and a ‘bewilderingly complex regulatory system’. ■■ While claims of privatisation had been exaggerated, the emphasis on competition has caused greater complexity and uncertainty about when to tender. 8
March 2015 | Volume 21 | Number 10
■■ The period since legislation has been characterised by regular ministerial intervention, despite the intention to reduce political interference. ■■ Commissioning has been fragmented between different bodies. ■■ NHS England has been slow to establish itself and weighed down by its wide-ranging responsibilities. However, the report does highlight some positive developments, including the close involvement of GPs in commissioning, giving local authorities responsibility for public health, and the establishment of health and wellbeing boards. It also states there has been progress in developing integrated care. King’s Fund chief executive Chris Ham says: ‘Historians will not be kind in their assessment of the coalition’s NHS reform. The first three years were wasted on major organisational changes, when the health service should have focused on its growing financial and service pressures. ‘Only latterly has the government adopted a more positive focus on improving patient
care and achieving closer integration of services. Politicians should be wary of ever again embarking on such a sweeping and complicated reorganisation of the NHS.’ The criticisms prompt the question: did the reforms lead to worse performance than otherwise would have occurred? Labour thinks so, with shadow health secretary Andy Burnham saying the changes have ‘harmed patient care’. He adds: ‘The sad truth is that, by turning the NHS upside down and causing a crisis in A&E, [prime minister] David Cameron has made care problems more likely, not less.’ The King’s Fund report lends some support to this view. It states that, while a causal relationship cannot be shown, it ‘seems likely that the massive organisation changes contributed to widespread financial distress and failure to hit key targets’. Case for the defence The criticisms led former health secretary Andrew Lansley, now stepping down as an MP, to defend his reforms: ‘The report is silent on whether patient care has been improved, on which the evidence is clear.’ ‘When I was health secretary, year-long waiting times were eliminated, hospital infections dropped to their lowest levels ever, and thousands of lives were saved, and continue to be saved, from improved care.’ A spokesperson for current health secretary Jeremy Hunt prefers to focus on the report’s references to patient safety and integrated care as being ‘right for the NHS’s future’. But whether or not the changes have made things worse, those on the front line think leading and managing in the NHS have become more difficult. Royal College of Nursing nurses in management and leadership forum chair Jane Valle says: ‘The past few years have been relentless for staff trying to manage wards, teams and hospitals. The overlapping pressures from change and financial problems have created a very difficult environment in which to lead.’ She says the focus is now turning to staffing and safety, but this too is causing problems: ‘There are not enough nurses in training and a number of staff are leaving. That will get worse as we have a lot of senior nurses reaching retirement age.’ NURSING MANAGEMENT
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Analysis
In the lead up to the 2010 election, prime minister David Cameron promised no more reorganisations of the NHS. Yet the coalition ended up introducing reforms that the then NHS chief executive Sir David Nicholson described as ‘so big you can see them from space’. So how did this happen? The King’s Fund review states that former health secretary Andrew Lansley believed the NHS could become more efficient through greater competition and streamlining of structures. But concessions were made to the Liberal Democrats to change the composition of primary care trusts (PCTs) to include directly elected members and others appointed by local authorities. The report states that Mr Lansley circumvented this process by requiring GPs to be involved in commissioning in what were to become clinical commissioning groups. It was eventually decided to scrap PCTs and strategic health authorities. To address Liberal Democrat concerns about the role of local authorities, it was proposed that health and wellbeing boards be created to bring together GPs and councillors. Opposition grew until the government was forced to ‘pause’ the reforms in April 2011 and re-consult, leading to the creation of the NHS Future Forum. Integrated care and clinical senates were prioritised, with clinical networks added to an ‘already complex structure’. RCN head of policy Howard Catton thinks this could be one of the important issues in the election campaign: ‘We are likely to see debate about nurse numbers; it’s a barometer for how the NHS has been doing.’ And he says there will be more rows about the reforms: ‘Labour will want to talk about this; they believe it’s a weak spot as far as the coalition is concerned.’
Service providers say plans to cut tariff will jeopardise ‘safe care’ Opponents cite growing financial pressures on hospitals as the reason for rejecting proposals. Nick Triggle reports CONCERNS ARE being raised about whether the NHS in England will be able to reach its savings target in the next financial year after talks to agree the new tariff system broke down. Proposals put forward by health service regulator Monitor and NHS England for 2015/16 were rejected by providers, amid claims that they would be unable to guarantee ‘sustainable and safe care’. About one third of providers opposed the plans, which equate to a 3.8% cut in prices, but this was enough to block the proposals as these opponents are responsible for 75% of NHS services. NHS Providers chief executive Chris Hopson says the decision was ‘not taken lightly’, but had to be made because of the growing pressures in the health service. The proposals represent the fifth successive year of significant cuts to the tariff, he claims. ‘Eighty per cent of hospitals are now in deficit and most are running their emergency departments at a substantial loss,’ he says. ‘Financial deficits are rapidly spread to mental health, ambulance and community trusts. Getty
History of the changes
Nick Triggle is a freelance journalist
Find out more To read the King’s Fund report, go to tinyurl.com/okf692a NURSING MANAGEMENT
Financial planning proves difficult as budgets are squeezed
‘NHS hospital, ambulance, community and mental health leaders are saying they can no longer guarantee to provide sustainable and safe care and meet their constitutional performance targets unless immediate changes are made to the way they are paid for their services.’ This opposition follows the announcement that Circle, the first private firm to run an NHS hospital, would be pulling out of its contract for Hinchingbrooke Hospital, Cambridgeshire, with the company blaming the challenging financial situation. The dispute over the tariff means the level will have to be determined by the Competition and Markets Authority, unless a resolution can be reached. In the meantime, 2014/15 tariff prices will be rolled over to the next financial year and the plan to increase the tariff for acute emergency work will not be introduced. Negative impact NHS England’s chief financial officer Paul Baumann says: ‘Any changes to the proposed tariff would in practice just be robbing Peter to pay Paul, meaning less investment in other hospitals, mental health or GP and community services, the exact opposite of what this winter’s pressures demonstrate is needed.’ King’s Fund director of policy Richard Murray says the rejection of the tariff could have ‘very significant’ consequences, with the NHS already posting a £630 million deficit at the 2014/15 half-year mark. ‘This is an unprecedented development. It’s not clear what the outcome will be; with just a few weeks to go before the start of the financial year, it will throw financial planning in the NHS into disarray.’ The two pricing authorities have subsequently put forward a second proposal, which is more generous. It amounts to savings of 3.5% and offers more money for emergency admissions and specialist activity. Trusts that do not accept this will stay on this year’s tariff until the matter is resolved, possibly by the Competition and Markets Authority if it ends up being referred there. Nick Triggle is a freelance journalist March 2015 | Volume 21 | Number 10
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Analysis
Report states that NHS reforms have led to fractured leadership King’s Fund review criticises coalition government for complex, ineffective reorganisation, writes Nick Triggle THE GOVERNMENT’S health reforms in England have been ‘damaging and distracting’, according to a review by the King’s Fund. The report, titled The NHS Under the Coalition Government, is critical of the decision to implement what it describes as ‘complex organisational changes’ when the NHS should have focused on dealing with growing demand and an unprecedented funding squeeze. The 82-page review states that the decision has led to a ‘strategic vacuum’ where there should be leadership and calls the whole process a ‘strategic error’. The King’s Fund says that: ■■ An unwieldy structure has emerged, with leadership fractured between several national bodies and a ‘bewilderingly complex regulatory system’. ■■ While claims of privatisation had been exaggerated, the emphasis on competition has caused greater complexity and uncertainty about when to tender. 8
March 2015 | Volume 21 | Number 10
■■ The period since legislation has been characterised by regular ministerial intervention, despite the intention to reduce political interference. ■■ Commissioning has been fragmented between different bodies. ■■ NHS England has been slow to establish itself and weighed down by its wide-ranging responsibilities. However, the report does highlight some positive developments, including the close involvement of GPs in commissioning, giving local authorities responsibility for public health, and the establishment of health and wellbeing boards. It also states there has been progress in developing integrated care. King’s Fund chief executive Chris Ham says: ‘Historians will not be kind in their assessment of the coalition’s NHS reform. The first three years were wasted on major organisational changes, when the health service should have focused on its growing financial and service pressures. ‘Only latterly has the government adopted a more positive focus on improving patient
care and achieving closer integration of services. Politicians should be wary of ever again embarking on such a sweeping and complicated reorganisation of the NHS.’ The criticisms prompt the question: did the reforms lead to worse performance than otherwise would have occurred? Labour thinks so, with shadow health secretary Andy Burnham saying the changes have ‘harmed patient care’. He adds: ‘The sad truth is that, by turning the NHS upside down and causing a crisis in A&E, [prime minister] David Cameron has made care problems more likely, not less.’ The King’s Fund report lends some support to this view. It states that, while a causal relationship cannot be shown, it ‘seems likely that the massive organisation changes contributed to widespread financial distress and failure to hit key targets’. Case for the defence The criticisms led former health secretary Andrew Lansley, now stepping down as an MP, to defend his reforms: ‘The report is silent on whether patient care has been improved, on which the evidence is clear.’ ‘When I was health secretary, year-long waiting times were eliminated, hospital infections dropped to their lowest levels ever, and thousands of lives were saved, and continue to be saved, from improved care.’ A spokesperson for current health secretary Jeremy Hunt prefers to focus on the report’s references to patient safety and integrated care as being ‘right for the NHS’s future’. But whether or not the changes have made things worse, those on the front line think leading and managing in the NHS have become more difficult. Royal College of Nursing nurses in management and leadership forum chair Jane Valle says: ‘The past few years have been relentless for staff trying to manage wards, teams and hospitals. The overlapping pressures from change and financial problems have created a very difficult environment in which to lead.’ She says the focus is now turning to staffing and safety, but this too is causing problems: ‘There are not enough nurses in training and a number of staff are leaving. That will get worse as we have a lot of senior nurses reaching retirement age.’ NURSING MANAGEMENT
Downloaded from RCNi.com by ${individualUser.displayName} on Dec 05, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Analysis
In the lead up to the 2010 election, prime minister David Cameron promised no more reorganisations of the NHS. Yet the coalition ended up introducing reforms that the then NHS chief executive Sir David Nicholson described as ‘so big you can see them from space’. So how did this happen? The King’s Fund review states that former health secretary Andrew Lansley believed the NHS could become more efficient through greater competition and streamlining of structures. But concessions were made to the Liberal Democrats to change the composition of primary care trusts (PCTs) to include directly elected members and others appointed by local authorities. The report states that Mr Lansley circumvented this process by requiring GPs to be involved in commissioning in what were to become clinical commissioning groups. It was eventually decided to scrap PCTs and strategic health authorities. To address Liberal Democrat concerns about the role of local authorities, it was proposed that health and wellbeing boards be created to bring together GPs and councillors. Opposition grew until the government was forced to ‘pause’ the reforms in April 2011 and re-consult, leading to the creation of the NHS Future Forum. Integrated care and clinical senates were prioritised, with clinical networks added to an ‘already complex structure’. RCN head of policy Howard Catton thinks this could be one of the important issues in the election campaign: ‘We are likely to see debate about nurse numbers; it’s a barometer for how the NHS has been doing.’ And he says there will be more rows about the reforms: ‘Labour will want to talk about this; they believe it’s a weak spot as far as the coalition is concerned.’
Service providers say plans to cut tariff will jeopardise ‘safe care’ Opponents cite growing financial pressures on hospitals as the reason for rejecting proposals. Nick Triggle reports CONCERNS ARE being raised about whether the NHS in England will be able to reach its savings target in the next financial year after talks to agree the new tariff system broke down. Proposals put forward by health service regulator Monitor and NHS England for 2015/16 were rejected by providers, amid claims that they would be unable to guarantee ‘sustainable and safe care’. About one third of providers opposed the plans, which equate to a 3.8% cut in prices, but this was enough to block the proposals as these opponents are responsible for 75% of NHS services. NHS Providers chief executive Chris Hopson says the decision was ‘not taken lightly’, but had to be made because of the growing pressures in the health service. The proposals represent the fifth successive year of significant cuts to the tariff, he claims. ‘Eighty per cent of hospitals are now in deficit and most are running their emergency departments at a substantial loss,’ he says. ‘Financial deficits are rapidly spread to mental health, ambulance and community trusts. Getty
History of the changes
Nick Triggle is a freelance journalist
Find out more To read the King’s Fund report, go to tinyurl.com/okf692a NURSING MANAGEMENT
Financial planning proves difficult as budgets are squeezed
‘NHS hospital, ambulance, community and mental health leaders are saying they can no longer guarantee to provide sustainable and safe care and meet their constitutional performance targets unless immediate changes are made to the way they are paid for their services.’ This opposition follows the announcement that Circle, the first private firm to run an NHS hospital, would be pulling out of its contract for Hinchingbrooke Hospital, Cambridgeshire, with the company blaming the challenging financial situation. The dispute over the tariff means the level will have to be determined by the Competition and Markets Authority, unless a resolution can be reached. In the meantime, 2014/15 tariff prices will be rolled over to the next financial year and the plan to increase the tariff for acute emergency work will not be introduced. Negative impact NHS England’s chief financial officer Paul Baumann says: ‘Any changes to the proposed tariff would in practice just be robbing Peter to pay Paul, meaning less investment in other hospitals, mental health or GP and community services, the exact opposite of what this winter’s pressures demonstrate is needed.’ King’s Fund director of policy Richard Murray says the rejection of the tariff could have ‘very significant’ consequences, with the NHS already posting a £630 million deficit at the 2014/15 half-year mark. ‘This is an unprecedented development. It’s not clear what the outcome will be; with just a few weeks to go before the start of the financial year, it will throw financial planning in the NHS into disarray.’ The two pricing authorities have subsequently put forward a second proposal, which is more generous. It amounts to savings of 3.5% and offers more money for emergency admissions and specialist activity. Trusts that do not accept this will stay on this year’s tariff until the matter is resolved, possibly by the Competition and Markets Authority if it ends up being referred there. Nick Triggle is a freelance journalist March 2015 | Volume 21 | Number 10
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