NHS reorganisation is important, but must not be a distraction from recovery

Our Chief Executive, Georgina Carr, looks at the NHS White Paper in greater detail.

Earlier this month, the Government set out its proposals for the most substantial NHS legislation in nearly a decade in its white paper ‘Working together to improve health and social care for all’. Like so many policy wonks in the sector, I have pored over the proposals with interest. Whilst I broadly welcome the principle of integration underpinning the reforms, in the words of the white paper in itself, “these proposals are not intended to add up to a coherent reform package in themselves…” – leaving a fair few questions about how exactly the proposed vision will deliver improved outcomes for people with neurological conditions.

Why do the proposals matter?

In essence, this document is about setting out the ways in which the NHS in England will work in an institutional and structural sense. It is not about re-writing the NHS Long Term Plan, or new spending commitments.

It matters because these proposals form the bedrock of how neurological services, across primary, secondary, tertiary and community care, will be planned and delivered in future. So, whilst neurology remains an under-prioritised clinical area (as indicated by their conspicuous absence from the LTP), these proposals could pave the way for important principles of good neurological care, including more seamless, integrated commissioning of services, better use of data (and sharing data more efficiently), and clarifying who exactly is responsible and accountable for the funding of different elements of neurological care.

What will change?

The document sets out a number of proposals of interest to the neurological community.

It proposes the establishment of Integrated Care Systems (ICSs) in statute, and states that ICSs will be required to set up an ICS board and an ICS Health and Care Partnership Board.

Finances will increasingly be organised on an ICS footprint. This means that parts of neurological care which are currently considered ‘specialised’ and commissioned at a national level will increasingly be commissioned at an ICS (or even community – ‘place’) level.  However, specialised commissioning policy and service specifications will continue to be led at a national level.

There is however an overwhelming shift towards expanded powers of the Secretary of State, including increased power to direct NHS England/Improvement, create new NHS Trusts, intervene in reconfiguration disputes and amend/abolish Arm’s Length Bodies (ALBs).

The proposals also seek to remove barriers to effective data sharing across different commissioners and providers, and also set out proposals to collect more detailed data about private healthcare and adult social care.

Finally, much of the Lansley reforms will be swept away, including repealing Section 75 of the Health and Social Care Act 2012, meaning NHS commissioners will no longer be compelled to put services out to competitive tender.

Could these proposals deliver better care?

In short, probably not.

The proposals should in theory make planning and delivery across different services easier – you’d hope that would mean that people with neurological conditions experience more joined up, seamless care.

But, changes to rules and legislation alone are unlikely to level up services for people with neurological conditions.  It takes change in behaviours and practice too. Indeed, many people with neurological conditions are unlikely to take a view on what level their service is commissioned at or where the money comes from.

Undoubtedly, the focus has to be on reducing unwarranted variation in access, and improving outcomes of treatment, care and support.  That means listening to the experiences of people with neurological conditions and those closest to them, as well as supporting our health and care workforce to deliver the most effective and efficient care possible.

On the listening part, the proposals fall short. We would certainly like to see a greater emphasis on the need for ICS’ to engage with their local community in particular.

Little clarity is given on the role of specialised commissioning in the future, and how exactly national service specifications will help to reduce unwarranted variation. The service specifications currently in use have not yet managed to level up care.

Social care in England is in desperate need of urgent and long-term investment and reform. The white paper does commit to bringing forward proposals on social care this year. Without significant reform or investment in social care, NHS reforms can only go so far. The same is true of workforce – we are still awaiting the workforce plans promised in the Long Term Plan, and their absence remains a glaring absence.

Context matters

Obviously, the Alliance, together with other infrastructure bodies and our members, will be doing our part to ensure the reforms provide a good basis to improve health and care outcomes. We are here and willing to work across Government to help make that happen. This includes:

  • Meeting with organisations across the sector to understand their perspective on the white paper
  • Working with our members and people with neurological conditions to refine our policy position
  • Working with infrastructure bodies to create the space and places necessary to collectively lobby on the bill
  • Map current ICS prioritisation of neurosciences
  • Develop tools and resources for the neurological community to engage with ICS’, including working with the National Neuroscience Advisory Group (NNAG) to set out optimum pathways of care

But in the short term, we want to see a clear recovery plan for services for people with neurological conditions.

People with neurological conditions have experienced profound disruptions to care over the past 12 months. Health inequalities have been laid bare throughout the pandemic, and indeed in the roll-out of the vaccination programme. Health and care professionals from across the country have done all they can to maintain care, and are, quite frankly, exhausted.

NHS reorganisation cannot be a distraction from these very pressing and real issues. So while we will engage with the legislative plans and endeavour to make them as good as they can be, we will continue to press on – listening to people with neurological conditions and our members – because at the end of the day if they’re not having a positive experience of services, NHS reform can only achieve so much.