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16.11.17

‘Extraordinarily difficult’ NHS management threatens local initiatives

The NHS management culture risks undermining local initiatives, the Nuffield Trust has warned.

In a new report, ‘A two-way street: What can CCGs teach us about accountability in STPs?’, the think tank argued that the NHS accountability structure is confusing, and the ‘command and control’ management style makes it difficult to implement local initiatives to improve joined-up care.

The study assessed the accountability and management arrangements of CCGs, using accounts from senior leaders and interviews with policymakers in NHS England, and analysed the implications on sustainability and transformation partnerships (STPs) and accountable care systems (ACSs) being developed across the country.

It found that policy agenda for CCGs is often set by NHS England rather than by clinicians responding to local need. This led to some CCGs being asked to adopt plans that they considered “unrealistic” or “counterproductive.”

The intention is that NHS England and CCGs should work collaboratively to improve patient care, but the report depicts “a more punitive, top-down approach,” with some leaders reporting a lack of control and autonomy over their organisations.

One NHS England leader noted that whilst they used to “coach” CCGs, they have now moved to “requiring them to make changes.”

This approach is causing stress and anxiety amongst the leaders themselves, with most CCG interviewees reporting feelings of little availability of support for them.

The think tank has warned that high levels of trust will be required between STPs and national NHS bodies if they are to avoid the same pitfalls experienced by CCGs.

It recommended that NHS leaders move away from a “heroic” model of leadership to one where responsibility and capabilities are shared.

Nuffield Trust senior fellow, Helen Buckingham, said: “The move to STPs makes sense: integrating NHS commissioning and service provision should in theory lead to better patient outcomes.

“But to succeed, local and national organisations will need to develop trusting and supportive working relationships – something that eludes the NHS all too often, as this study suggests.

“Despite the laudable aspirations of fostering collaboration and local leadership underpinning them, the experience of CCGs is that when pressures start to grow, the NHS reverts to type, with national bodies making ever more directive demands of local organisations, and local leaders feeling isolated and demoralised.

“There is an opportunity to rectify this pattern of behaviour with the move to STPs, but this will require a significant change in approach at all levels in the health service.”

NHE has contacted NHS England for comment.

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