2013 will see renewed battles over NHS reconfiguration, as clinical and financial pressures compete with short-term political interests ahead of the next election
The government’s NHS reforms have done little to prevent the main change that will need to take place to ensure that our health service survives and thrives in any meaningful way in the future. Namely, the major reorganisation of many of the patient services that are at present delivered from NHS hospitals.
In the last few days of 2012, the NHS Confederation was putting the argument for change. The NHS reforms, as we shall see, will alter the architecture through which this will happen, but the arguments for clinical and financial change are becoming stronger and stronger.
We can be certain that with a view to the election – now just over two years off – Number 10 will be trying to stop these changes. Given that the government have now appointed a Conservative-whipped peer to the Independent Reconfiguration Panel; and given that the IRP is the court of last resort for hospital reconfigurations, some of the necessary reconfigurations may change. But the majority of them will be under discussion with the public over the next two years.
In some ways the new architecture will increase pressure for reconfigurations. I am sure that there will be memos from Number 10 asking the Secretary of State to keep track of all these hospital reconfigurations. One of the more amusing conversations in the Department of Health will occur when the recently appointed health secretary, Jeremy Hunt, asks who will help him keep track.
He will be told that, under the old regime, this was the job of the strategic health authorities. He will also be told that these were abolished by the reforms he agreed to in cabinet.
What replaced them? That’s not easy to determine. The main local drivers for change within the new system will be local clinical commissioning groups. They will be under clinical and financial pressure both to commission different services and to reduce the number of services delivered within their local hospital. Some of these reconfigurations will have already been authorised based on their plans to achieve this, and some of them will believe that it is actually their job to implement their own plans.
And (to try and help the new secretary of state) if it’s anyone’s responsibility to help him prevent them from doing this it will be the new National Commissioning Board. However, in order to achieve this it will have to move beyond its current remit in at least two ways.
First the secretary of state does not have the same relationship with the NCB that he enjoyed with the SHAs. From April 2013 onwards he will no longer have the opportunity to sit on his sofa every Monday (as he can at the moment) and discuss with one of his permanent secretaries, Sir David Nicholson (CEO of the NCB), what he thinks he can do to make sure CCGs don’t reconfigure hospital services.
The legislation that the new secretary of state agreed in Cabinet, means that from April Sir David Nicholson, and the entire NCB, will be independent of the secretary of state.
The second clue to the change in legislation, with which the current secretary of state agreed, can be found in its title. The NCB is a commissioning organisation. Whilst commissioners will be driving reconfigurations, it is difficult to see how there is any remit for the NCB to actually stop reconfigurations.
The secretary of state has just agreed a mandate between himself and the NCB which instructs the NCB on what it should do over the next two years. This mandate did not include an objective to 'try and stop CCGs from reconfiguring hospital services.'
All of this means that whilst there may indeed be a nod and a wink between the secretary of state and the NCB to restrain CCGs, this will have to be done outside of the main remit of the relationship.
It will be interesting to see how the health secretary uses his newly limited powers to resist the historical forces that the NHS Confederation describes.
Paul Corrigan was formerly senior health policy adviser to Tony Blair when he was prime minister. This post first appeared on Health Matters
