NHS England chief executive Simon Stevens has promised to end the ‘fractured’ health and social care system by empowering local leaders to drive improvements in their areas.
Mr Stevens said too many patients are ‘passed from pillar to post’ – and revealed that a number of areas of the country, covering seven million people, would be designated as ‘accountable care systems’, a new framework which would allow commissioners and providers to bypass tendering and competition rules.
There remain questions, however, on whether the new structures would stand up robustly to legal challenge.
Speaking at the NHS Confed 17 event in Liverpool Mr Stevens said ACSs (accountable care systems) would build on work already done by vanguard schemes in local areas – and would focus on taking pressure off emergency medicine, investing in general practice, and improving access to cancer care and mental health services.
Mr Stevens said: ‘As the NHS approaches its 70th birthday, we are now embarked on the biggest national move to integrating care of any major western country. For patients this means better joined-up services in place of what has often been a fragmented system that passes people from pillar to post.
‘We are now embarked on the biggest national move to integrating care of any major western country.’
No legal basis
The move toward ACS has been controversial as the new structures have no mention in the Health and Social Care Act 2012 – and thus no proper legal basis of governance framework.
But during the course of the NHS Confed 17 event several national and local leaders said they would do whatever possible within current law to progress the changes, with new legislation under a minority Conservative government focused on Brexit very unlikely.
Outgoing NHS England medical director Professor Sir Bruce Keogh said: ‘We need to heal fractures between services and tear down those administrative, financial, philosophical and practical barriers to the kinds of services our patients want us to deliver. To get there, we must replace the fear of change with convincing arguments for the future – or I for one worry that risk weakening our greatest social asset through inaction or fatigue.’
The ACS programme would likely see local areas given budgets to make decisions about how to structure care locally and access to £450m of transformation funds to increase integration.
The areas chosen to make the first changes are:
- Frimley Health including Slough, Surrey Heath and Aldershot
- South Yorkshire & Bassetlaw, covering Barnsley, Bassetlaw, Doncaster, Rotherham, and Sheffield
- Nottinghamshire, with an early focus on Greater Nottingham and Rushcliffe
- Blackpool & Fylde Coast with the potential to spread to other parts of the Lancashire and South Cumbria at a later stage
- Luton, with Milton Keynes and Bedfordshire
- Berkshire West, covering Reading, Newbury and Wokingham
The BMA has repeatedly called for Government and NHS leaders to ensure proper governance frameworks are in place before changing structures.
BMA council chair Mark Porter said: ‘We’ve been calling for the purchaser provider split to be removed in the health service for years and it’s good to see the NHS has finally recognised this.
‘We called for the HSCA (Health and Social Care Act 2012) not to be brought into law because we felt its mechanisms were untested, unlikely to be of benefit and would harm the NHS. It would seem there is now a consensus that we were right.
‘It is not wrong to have second thoughts and row back from what was done, but the way the NHS is actually run is now outside the legislative framework governing the NHS. There are potentially serious governance problems.
‘One wonders about the extent to which it’s actually possible to carry on running with an improvised structure – under law we should be doing something else.'
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