The NHS in England is about to embark on a substantial programme of reform made more challenging by ambitious efficiency targets and large cuts to management. This Nuffield Trust policy response identifies ways to minimise the risks associated with these changes as well as capitalise on the opportunities they present.
The period from 2011 to 2014 is likely to be the most challenging ever faced by the NHS. Primary care trusts (PCTs) are required to hold 2 per cent of their allocations with Strategic Health Authorities (SHAs). Allowing for this, the recurrent resources available to PCTs to spend in 2011/12 fall by 2.3 per cent on average in real terms, with a minimum cut of 0.3 per cent and some PCTs facing a reduction of 2.5 per cent. Providers face the challenge of making a 4 per cent overall efficiency saving at the same time as they experience a 1.5 per cent cut to the tariff by which they are paid.
Against this backdrop, this Nuffield Trust policy response provides a comprehensive analysis of the challenges associated with implementing the 2011/12 Operating Framework, together with guidance on the operation of Payment by Results (PbR) in 2011/12. It identifies ways in which the risks associated with transition to a reformed NHS might be mitigated.
This report identifies ways in which the risks associated with the transition to a reformed NHS might be mitigated
The 2011/12 Operating Framework for the NHS seeks to fulfil three priorities: to maintain and improve the quality of services, building on success to date; to retain financial control and meet the quality and productivity challenge; and to make progress on the transition to a reformed NHS as envisaged in the White Paper: Equity and Excellence: Liberating the NHS.
NHS reforms in England: managing the transition calls for early development of clear guidance on the governance and structural arrangements for emerging GP consortia, to ensure adequate local and national accountability for quality, financial control and value for money.
The authors stress that the role of PCT clusters will be critical and extensive – if they are to retain staff and effectiveness they will need support, more clarity as to their priorities, and assurance of a future beyond 2013. They also call for more support for PCT clusters and shadow GP consortia in handling the essential reconfiguration of services, in particular with regard to hospitals.
NHS reforms in England: managing the transition will be of interest to policy-makers, NHS commissioners and all those with a current or potential future responsibility in this area.
Smith J and Charlesworth A (2011) NHS reforms in England: managing the transition. Policy response. Nuffield Trust.