The Second NHS Reorganisation is Well Under Way

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“NHS funding growth is much slower than the historic long term trend.”

“Real terms funding per person will go down in 2018/19 and 2019/20.”

“The public are concerned for its future.”

“There is likely to be continued pressure on waiting times for routine care and some providers’ waiting times will grow.”

The words above are not taken from a Labour press release or a critical speech in Parliament, but from a new NHS England Plan, Next Steps on the NHS Five Year Forward View, which was published this week.

The document confirms that the NHS does not expect to meet the A&E target, to see 95% of patients within 4 hours, which Jeremy Hunt described as being “critical for patient safety,” for at least the next year. It also sets out plans for another round of rationing of treatments and the abandoning of the 18 week waiting target for surgery.

The document, gloomy though it is, provides a realistic assessment of what is and isn’t achievable within the financial constraints that the NHS is operating in. Nor is it entirely without positives such as the welcome ambitions around cancer care and mental health, which Labour fully endorses, though the chasm between Government rhetoric and reality in these areas is huge.

It also very clearly does confirm once again that despite repeated assurances from Theresa May and Jeremy Hunt, the NHS has not been given the funding settlement that it asked for and patients will pay the price.

You would be right to expect that a frank assessment of the challenges facing the NHS, coupled with a plan for new governance arrangements and departure from nationally agreed targets would receive forensic scrutiny in Parliament. You would expect a detailed statement from the Health Secretary, followed by questions from MPs about why NHS funding has not kept up with demand and why a “critical” target will be missed for another year. You would expect an answer from Jeremy Hunt as to whether he considers the NHS Constitution is still actually a document that is binding on Government.

Unfortunately, this announcement came on the first day of the Easter recess, so there was no statement and no scrutiny. The Health Secretary who wants to deliver a 7 day NHS has also once again gone missing at a time when serious questions are being asked about his stewardship of the Department for Health.

The most striking thing about the new plan is the confirmation that not only did the 2012 Health and Social Care Act waste billions of pounds, it has also been an abject failure. The payment by results system is being quietly shelved, while there is a desperate rush to replicate the functions of the Strategic Health Authorities that the 2012 Act scrapped.

This second reorganisation is happening much less publically than the first one. Whilst there was some publicity surrounding Sustainability and Transformation Plans, there has been much less coverage of the Vanguards or the move towards Accountable Care Organisations which feature heavily in the new document. The Healthwatch guidance on ensuring that local people have their say recommends that organisations should “involve local people from the start in coming up with potential solutions.” Based upon this test, the exercise has already been an abject failure, while there are also question marks over whether changes on this scale could be open to legal challenge without further legislation. Will the abandoning by the Government of the 18 week waiting time target for treatment also lead to a legal challenge because the NHS Constitution has been broken?

However, possibly the most alarming prospect thrown up by this reorganisation is reference to the establishment of Accountable Care Organisations, which the plan says will lead to commissioners having “a contract with a single organisation for the great majority of health and care services and for population health in the area.” We will be seeking urgent confirmation that the ‘single organisation’ will be part of the public sector.

The concern is that this opens the door to huge contracts to private providers as the lack of a clear legal framework for these new commissioning arrangements makes a challenge likely if they are not given the same opportunity to bid as public sector bodies.

Finally, the statement “some organisations and geographies have historically been substantially overspending their fair shares of NHS funding” which “may mean explicitly scaling back spending on locally unaffordable services” will send a chill down the spine of anyone who works or is currently a patient in the NHS. They will know that services are already stretched to breaking point and this move to single out sections for further cuts could well push parts of the health service over the edge. We deserve better than the future strategy for the NHS being reduced to an exercise in expectations management.