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Navigating Change in the NHS: Understanding the New Landscape and Its Complexities

The NHS is undergoing significant changes, impacting commissioning, provider autonomy, regulation, and decision-making. Fragmentation and confusion characterize the new system. Key drivers include competition, choice, integration, and the evolving role of the Secretary of State. Issues around accountability and strategy arise, with a need for clearer rules and responsibilities. New organizational structures, like the NHS Trust Development Authority, aim to address these challenges, but uncertainties remain regarding the effectiveness of integration, procurement, and the overall financial health of the system.

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Navigating Change in the NHS: Understanding the New Landscape and Its Complexities

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  1. System changes & impact on the NHS Nigel Edwards John

  2. Reform on one page • Commissioning – Fragmented • Providers – more autonomous & plural • Regulation – confused • Change drivers – competition, choice, integration and direction • Secretary of State – in theory taken out of day to day issues • Rules of the new system – not clear yet

  3. New landscape..... New organisations/bodies The Mandate NTDA NHS Trust Development Authority 112 Trusts FT Pipeline (Jan 2012) CSS

  4. What does it all mean?

  5. Uncertainty • Accountability – who is really responsible for what • Decision making • Competition & mergers • Procurement • Strategy

  6. No strategy function • Many different actors • A more local focus • Agreement & implementation harder

  7. Strategy & the wider system • Issues about the size of some CCGs in relation to the wider system • Federated arrangements are not present in many places and are hard to make work

  8. Signs of the strategy gap being filled • NHS England will develop a strategy • Seven work streams • Rationalisation of tertiary care • New offer from primary care • New financial regime • Bill McCarthy talking about regional planning • Will AHSNs do some of this?

  9. But, still more pressures to change • Commissioning guidance • A focus on quality • E.g. Signs that NHS England will be pushing 24/7 consistency • This has particular implications for out of hours surgery

  10. Known unknowns - Behaviour • The intention was to break the system and change the culture – did enough get broken? • How will the people in the new bits of machinery actually behave? • What will happen when things start to unravel? • Do the players understand the new architecture & behave accordingly?

  11. Changes in primary care • Worrying situation on demand and workforce • A possibly unanticipated change also driven by static GMS funding is a realisation that primary care needs to change too • More federated arrangements emerging • New contracts • Arrangements for out of hours likely to change

  12. Integration • Much enthusiasm for this but it is hard to do • Part of the problem is complexity and overlap created by multiple initiatives and projects • There are big opportunities but it is harder to do than it first appears • Procurement and payment mechanisms are an issue • It costs before it pays

  13. Concerns • Financial situation in health and particularly social care • Plans to deal with this are not very convincing • A significant number of organisations in difficulty • No very clear way forward for the trusts that will not make FT status

  14. On the upside • New ideas and commissioners with a clinical focus • A shift to commissioning on outcomes rather than input and process (I hope) • Health and Wellbeing Boards • A strong consensus that change is required

  15. Questions and discussion n.edwards@kingsfund.org.uk

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