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Providing for the future

The NHS reforms have become truly concrete this summer, as the new organisations get up and running, CCGs find their feet, top teams get appointed and we get a better sense of how it’s all going to hang together in the future.

It’s obvious that the CCGs are not quite what was envisioned in the original white paper: they are more standardised, more regulated, more homogenous and just more like the PCTs they are replacing. This might make for a more coherent and understandable structure for patients – and perhaps for the NHS at the centre too – but it does mean that radical experimentation, with GPs and clinicians trying new things and new ways of working, is a lot less likely.

This summer has also seen South London Healthcare Trust placed into special measures, with a special administrator from the Department of Health appointed – which is ominous for many other struggling hospital trusts who may have been counting on ongoing cash bailouts into the future. The new NHS Trust D e v e l o p m e n t Authority will have its work cut out for it – although its job is ostensibly to help these trusts deliver safe, high-quality and financially s u s t a i n a b l e healthcare and to guide them towards FT status, many of them are in such dire budgetary positions that the TDA’s job will be more like crisis management.

So much debate around the reforms has focused on commissioning, but if anything the shake-up on the provider side – because of economics rather than legislation, to a large extent – may well end up the bigger story. The coming ructions and inevitable mergers, take-overs and closures will show for definite which hospitals and trusts have been struggling because of poor management, and which are just in systemically unsustainable positions due to supply and demand, over-capacity, demography and geography.

Those who think the future is private companies running NHS hospitals got a small boost when Circle Health-run Hinchingbrooke came joint top of the first ‘friends and family’ survey, which covered 46 acute and foundation trusts across the east of England and the Midlands.

Over 22,000 patients were asked at the end of their treatment, “how likely is it that you would recommend this service to friends and family?”, and Hinchingbrooke got a ‘score’ of 89%, based on subtracting the number of detractors from the number of promoters. By contrast, the worst-performing hospitals were languishing with scores in the high 20s and low 30s.

The NHS Commissioning Board itself has been growing, with more non-executive directors appointed: many of them from outside the traditional NHS bureaucracy and willing to speak their mind. Perhaps the change the struggling providers need will come from those responsible for commissioning.

Adam Hewitt - Editor

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