NHS heading for its ‘toughest year’

The NHS faces potentially “the toughest year in its 62-year history” as the service embarks on its biggest reorganisation, health service managers have warned.

Civil servants are drawing up the biggest piece of NHS legislation ever – far longer than the 1946 act that founded the service – as GPs are given control of up to 80 per cent of the NHS budget and a new commissioning board and economic regulator replace existing health authorities and primary care trusts.

“The disruption and potential loss of momentum is a key concern”, said Nigel Edwards, acting chief executive of the NHS Confederation, which represents health authorities and trusts. Mr Edwards said his organisation supported the objectives of health secretary Andrew Lansley’s plans, but their radicalism needed to be understood.

“The state will be withdrawing from the day-to-day management of healthcare,” he said, with power and accountability operating in a new and different regulatory environment.

The service would become “like a regulated industry” on the lines of the telecommunications, water and energy industries, with a series of more loosely connected organisations operating in a market split between purchasers and providers of healthcare.

“That could trigger major reshaping of the way care is delivered, with services closing and changing,” he said. To deal with the financial issues “there will need to be some bold decisions about the future of some services and institutions”.

The government needed to tell “a compelling story about why the reforms will deliver a significant improvement for patients, and how they will work in practice”.

Important “grey areas” remain over precisely who will do what, and how it will be overseen, and there are questions over wether the coalition’s plans for more patient choice will prove to be a powerful enough lever for change.

But it is “the transition to the new system that is causing the greatest anxiety in the NHS”, Mr Edwards added, with the drive for up to £20bn of efficiency savings likely to have a negative effect on patients.

Nicholas Timmins
The Financial Times

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