Reform, reform and reform

By - Integrated Care Journal

Reform, reform and reform

One of the most famous speeches made relating to policy prioritisation was Tony Blair’s speech at the Labour Party Conference in 1996. In this speech Blair proclaimed that his three main priorities for Government were ‘education, education and education’.

The UK has now had a Conservative Government for 11 years, and although we have had three different leaders, none of whom have ever proclaimed the priority as proudly as Blair did regarding education, when it comes to healthcare the motto has very much been ‘reform, reform and reform’.

Firstly, the 2012 Health and Social Care Act brought the most wide-ranging reforms of the NHS since it was founded in 1948. The creation of Clinical Commissioning Groups (CCGs) led to care being delivered at a local level that hadn’t been seen before. However, they were often plagued by power struggles around how to hold CCGs accountable for the care they commissioned.

Fast-forward to 2018, the Government signalled their intent to reform Social Care by creating the new Department of Health and Social Care. The move was widely welcomed by all in the health and social care sectors. It was seen as the long-awaited opportunity to combine Health and Social Care delivery, creating a truly holistic approach to care delivery. However, three years on and this has only been a superficial change. The continued promises of Social Care reform have failed to materialise, a Green Paper was promised in 2017 and again in 2019, it was then said a White Paper would be released instead, but still nothing.

Instead, a new NHS White Paper has been released, promising social care reform to follow later in the year. The paper offers a solution to some of the problems the 2012 Health and Social Care Act brought, focusing on ending competition and competitive tendering and providing a statutory footing for Integrated Care Systems.

Unlike the legislative changes in 2012, that were largely forced on the NHS, the new White Paper adopts changes the NHS has already been leading on and had asked the Government to legislate around them.

Statutory footing for Integrated Care Systems (ICSs), which will absorb CCGs and their role is the headline commitment and had been long expected to arrive in 2021. ICSs have been in the works for years now and will be key in ensuring the health needs of local populations are met. The impact of the Covid-19 pandemic has clearly disproportionately affected some communities in the UK, for example the elderly and ethnic minorities. ICSs will be key in tackling the health inequalities, that have always existed in the UK, via a tailored approach.

What the NHS hadn’t called for was the changes to ministerial oversight that have been included in the white paper. The changes boil down to mean that the Secretary of State will oversee NHSE and all ICSs. There is clear trepidation over this move, particularly as Government led interventions during the current pandemic have paled in comparison with those that have been led by the NHS, the typical example being Test and Trace vs the vaccine rollout.

However, the move is understandable from a Government which often bears the brunt of the ire when things go wrong in the NHS but is unable to take the plaudits when things go well, due to a lack of clear accountability.

The systemic changes the White Paper, and the theory behind them, will be discussed in detail over the coming months. Many organisations will shift focus onto influencing legislation and it being at the forefront of change rather than service level developments. However, the two words that must focus minds on healthcare reform, and making a success of whatever legislation exists are: Patient outcomes.

The NHS is clearly still overburdened in its response to the Covid-19 pandemic with record numbers of people admitted to hospital because they have contracted the virus. However, with the mass vaccination effort well underway, the new, post-pandemic NHS is in sight.

How this legislation enables the NHS and Government to urgently restart services in order to tackle the huge backlog of outpatient appointments and missed diagnoses will be the judge of its success in the short term.

But there is a long-term need to ensure the way we manage the health of the UK’s population does not just mean a return to the pre-pandemic status-quo. For all the plaudits the NHS receives, and rightly so, patient outcomes lag well behind other nations that the UK would like to be comparable to. Indeed, in their last report, the Commonwealth Fund found that the UK ranked 10th out of 11 countries analysed in terms of patient outcomes.

It is for this reason that Public Policy Projects are building a new coalition, made-up of the UK’s leading minds within health and social care to build consensus and create our vision for a truly universal healthcare system. The coalition will ensure the NHS doesn’t just build back quickly but builds back stronger following the pandemic, focusing on improving patient outcomes throughout the entirety of our work.

For more information, and to join the NHS Restart and Rebuild Coalition get in touch with Lloyd Tingley at or on 07540 554206.

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