News / Government must act on reform challenges

The government must set out practical solutions to the challenges raised by its health service reforms, including governance and the financial risk of transition, the NHS Confederation said.

A confederation discussion paper said the increasing controversy over the NHS reforms in England is destabilising the health service and stifling debate over how they should be implemented.

 ‘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,’ said Confederation acting chief executive Nigel Edwards. ‘This is destabilising for an NHS that is already making structural changes to meet the government’s agenda.’ 

Concerns fell into four categories – competition, commissioning consortia, accountability and risks of transition.

The paper, Where next for NHS reform?, said competition could improve quality and efficiency, particularly where prices are fixed.

There were concerns that the transition risks were too great, particularly when the NHS was also striving to deliver £20bn of efficiency savings. Relaxing the implementation timetable, allowing local flexibility over how and when reforms are put in place, could alleviate this.

The paper said the government could also reduce transition risks by ensuring consortia are not handed financial and structural problems – particularly hospital reconfiguration and trusts that will probably never be ready for foundation status.

Decisions over some hospital reconfigurations had stalled for years. The confederation called on the government to resolve these issues so the trusts affected could enter the new era on a sound financial footing.

Some trusts will never become foundations because of underlying financial problems. The confederation said the government should set out which organisations are at risk of not achieving foundation status and how it will go about resolving their problems.

GPs may have a conflict of interest if they are both commissioners and providers of care and there should be clear guidance on how such conflicts should be managed. The confederation suggested open-book accounting to ensure effective scrutiny of GPs’ profits.

Similarly, it said the government should provide a clearer explanation of how a commissioning outcomes framework might work to counter fears that GPs might personally benefit from decisions not to refer patients.

The government must set out practical solutions to the challenges raised by its health service reforms, including governance and the financial risk of transition, the NHS Confederation said.

A confederation discussion paper said the increasing controversy over the NHS reforms in England is destabilising the health service and stifling debate over how they should be implemented.

 ‘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,’ said Confederation acting chief executive Nigel Edwards. ‘This is destabilising for an NHS that is already making structural changes to meet the government’s agenda.’ 

Concerns fell into four categories – competition, commissioning consortia, accountability and risks of transition.

The paper, Where next for NHS reform?, said competition could improve quality and efficiency, particularly where prices are fixed.

There were concerns that the transition risks were too great, particularly when the NHS was also striving to deliver £20bn of efficiency savings. Relaxing the implementation timetable, allowing local flexibility over how and when reforms are put in place, could alleviate this.

The paper said the government could also reduce transition risks by ensuring consortia are not handed financial and structural problems – particularly hospital reconfiguration and trusts that will probably never be ready for foundation status.

Decisions over some hospital reconfigurations had stalled for years. The confederation called on the government to resolve these issues so the trusts affected could enter the new era on a sound financial footing.

Some trusts will never become foundations because of underlying financial problems. The confederation said the government should set out which organisations are at risk of not achieving foundation status and how it will go about resolving their problems.

GPs may have a conflict of interest if they are both commissioners and providers of care and there should be clear guidance on how such conflicts should be managed. The confederation suggested open-book accounting to ensure effective scrutiny of GPs’ profits.

Similarly, it said the government should provide a clearer explanation of how a commissioning outcomes framework might work to counter fears that GPs might personally benefit from decisions not to refer patients.