03.11.16
Milburn warns current NHS structures ‘complex and confused’
The current national system of healthcare oversight is too confused and should be replaced by local bodies, along the lines of sustainability and transformation plans (STPs), with the power to commission health and social care, according to a new report from PwC.
The ‘Redrawing the health and social care architecture’ review, led by former health secretary Alan Milburn, said that the attempt to delegate responsibility for health to CCGs under the Health and Social Care Act 2012 “may have worked” with more time, but was instead “an imperfect plan from which policymakers were forced to beat a hasty retreat”.
This meant they had introduced elements of central control with no overall plan, leaving “a complex middle-ground between central control, devolved decision-making and a market-based approach”.
Milburn said: “Despite the best efforts of its leaders to make it work, the current national architecture is confused and complex. The artificial divide between health and social care makes as little sense as the division of labour between a myriad of national bodies.”
He added that organisational change is always a risk but without it, the move towards integrated local care systems will be undermined.
A survey by PwC found that only 30% of NHS staff were clear on the role of NHS England and the DH, while only 16% were clear on the role of NHS Improvement.
Furthermore, nearly three-quarters of NHS staff said they would like to see the national structure reformed, and only 11% thought the current arrangements were effective.
The report’s authors found that there was now a consensus in the health system that health and social care should work more closely together, but added it was being held back by the structure of regulation.
David Morris, PwC partner and author of the report, said: “Our research highlights a persistent underlying sense of confusion about the roles of national bodies in the NHS, coupled with frustration over the division between health and social care. Evidently there is growing appetite for reform.
“It is essential that this debate does not fall to the bottom of the pile and I hope this report is a welcome addition to the discussion and helps point to some much needed solutions to the growing problems the NHS faces.”
To solve the problem, PwC said NHS England should build on the work of the STPs by establishing permanent Regional Care Groups (RCGs) with the power to commission primary care and specialist services. They could be aligned to local STP footprints where this was suited to existing community and hospital boundaries, or else new alignments might be needed.
In the short term, PwC also recommended creating a Care Management Board to bring together the chief executives of NHS England, NHS Improvement, Public Health England and Health Education England, as well as representatives from the care sector.
It was also suggested that the DH and Department for Communities and Local Government should also agree a common strategy for health and social care.
In the longer term, the report said RCGs should evolve into democratically accountable local bodies, replace CCGs in the health commissioning function, and also commission social care. Local systems would also have the power to raise money for healthcare through taxation.
Manchester, the first region in the country to gain devolved healthcare powers, has already proposed merging its three CCGs with the city council to create a single body with responsibility for health and social care commissioning.
The report added that local commissioning was “necessary to break the accountability stranglehold exercised by Whitehall over local care systems”.
But it noted that the process of changing would be “lengthy, complex and potentially costly”, and different areas should be allowed to move at different speeds. It was recommended that this process should be matched by changes at a national level, including merging NHS England and NHS Improvement and establishing a single Department of Health and Care.
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