Commenting in response to Liberating the NHS: Legislative Framework and Next Steps, published today by the Department of Health, Nuffield Trust Chief Executive Dr Jennifer Dixon said: ‘The NHS is facing two huge challenges in the period to 2014. The first is the need to make £15-20bn of efficiency savings. This level of efficiency – 4 per cent per year – has never been made in the NHS’s history. Second, an unprecedented shake-up to the way care is organised and delivered in the NHS in England. Within this context the broad direction of reform – to reduce political direction over the NHS by politicians – is significant and the right one.
‘But the scale of reform is very fast and risks distracting efforts to achieve the efficiencies now urgently needed and maintain a grip on NHS finances. The change to the statutory framework of the NHS is profound and fundamental, moving direct NHS accountability from the Secretary of State to the new NHS Commissioning Board (now NHS England) and taking away the ability of the Secretary of State to direct NHS organisations, unless in exceptional circumstances. Time will tell what this means but this is very significant in terms of performance management, especially at a time of such financial challenge and management turmoil. The main concern must be that the quality of care patients receive does not suffer, but it is at risk as quality is not as easily measurable as costs.
‘While the Government must be commended for largely protecting NHS funding over the next spending review period up till 2015, the reality is that the £2.6 billion cash increase for frontline services announced today will not result in a real terms increase in NHS funding. Our analysis shows that the NHS will receive a real terms reduction of 0.5 per cent in its funding over the next four years – after the £1billion a year that will be transferred to social care is taken into account. On top of this, inflation estimates have already been revised upwards since October’s Spending Review and this has further eroded the purchasing power of the NHS budget.’
Commenting further on the plans to move all NHS trusts to foundation trust status and handing control of NHS budgets to GP Consortia, Dr Dixon added: ‘The Government shows that it has listened to responses to the White Paper. NHS Trusts have been given another year to become autonomous foundation trusts – this is welcome. But it is still unclear what will happen to the 20 or so hospitals they acknowledge that are unlikely to ever achieve foundation status in their current form.
‘However, there is no let up in the pace of change for handing power and control of NHS budgets to GP Consortia. Creating pathfinders of the most enthusiastic GPs is a good start but the majority of GPs up and down the country will be harder to engage. The risk is that there will not be enough time to learn valuable lessons from the vanguard pathfinder group. This must be a cause for concern given that £80bn of public money is being handed over to GP consortia.
‘There are still many important unanswered questions. For example, how conflicts of interest will be dealt with in terms of GPs’ responsibilities as both providers and commissioners of patient services, and who will discipline providers of primary care services that deliver poor quality care. And little appears to have changed to resolve how GP consortia will be made fully accountable to their local communities. There is very little detail about how local people will be able to directly influence GP consortia. Today’s report confirms that the Government hopes that GP consortia will not inherit outstanding primary care trust ‘legacy debts’ but how this will be paid for given constrained health care budgets is a concern.
‘Finally, the creation of a ‘banking facility’ operationally independent of the Department of Health to manage its investment stake in foundation trusts is welcome. But it should be fully independent, rather than solely ‘operationally’ independent, and cover commissioners as well as foundation trusts.’