New NHS needs freedom to tackle its biggest problems not "a tsunami of bureaucracy" says Farrar

Published on Thursday, 23 August 2012 14:27
Written by Scott Buckler

NHS leaders fear the Government's structural reforms will lead to "a myriad of conflicting polices" and "a tsunami of bureaucracy", the head of the NHS Confederation warns today

Mike Farrar, the organisation's chief executive, makes the comments in an article for specialist healthcare magazine, Health Service Journal.

The Government is setting up a range of new organisations to run the NHS in future, with at least seven new bodies impacting on the NHS day-to-day.

Mr Farrar says their collective impact must be to help, rather than hinder, NHS leaders who will continue to tackle major financial problems, reduce hospital admissions and move care closer to people's homes. He says the senior teams of each organisation will need to co-ordinate their priorities and behaviours if they are to secure the confidence of frontline health service leaders.

Mr Farrar highlights the results of a major survey of NHS chairs and chief executives which reveal significant concerns about the new organisations [see notes to editors].

Fifty seven per cent of respondents highlighted a lack of expertise or experience in the new organisations as the biggest risk to the government's NHS reforms.

Other major risks highlighted by respondents were disruption caused by organisational restructuring, financial pressures of cost saving targets (both 54 per cent), and a lack of system management (cited by 46 per cent).

The survey also shows that NHS leaders' confidence varies in the readiness of the new organisations to effectively discharge their responsibilities in 2013. Sixty eight per cent said they were confident about the readiness of Monitor in its new role as economic regulator. A majority of respondents also said they were confident about the readiness of the NHS Commissioning Board and the NHS Trust Development Authority.

However, they raised significant doubts about the readiness of the Care Quality Commission and HealthWatch. Eight out of ten respondents said they were not confident HealthWatch will be ready to take on its responsibilities.

And 69 per cent said they were not confident that the CQC would be ready to effectively discharge its responsibilities in 2013.

Mr Farrar offers a three-part prescription for the new organisations to make sure they provide leadership and support to the service.

He said:

"To be successful, these new organisations must listen – and keep listening – to NHS leaders. They must avoid overwhelming NHS organisations with complexity and instead focus on the critical overarching concerns that will matter most in the end.

"It's essential that national bodies ensure they are driving towards the same goals, not subjecting the NHS to a myriad of conflicting policies. Otherwise the NHS will be pulled in different directions and unable to make progress.

"They need to minimise the burdens their policies place on the system by making it as easy as possible to comply. With so many new structures, the danger of a tsunami of new bureaucracy is obvious. The NHS must stay focused on patient care, not repeatedly providing information in different formats to multiple bodies."

Mr Farrar also says the way the organisations conduct themselves will be crucial to making the new system work:
"Behaviours will be much more important than what it says in the rule book, so the way individual leaders exercise their responsibilities will be critical. They should prioritise collaboration with others, on behalf of all patients, not advancement of narrow sectional interests."

In his article, Mr Farrar also urges the national bodies to empower local commissioners to do the right thing for patients:

"Clinical Commissioning Groups have the potential to make huge improvements to local services if – and it's a big if – the new system gives them the freedom they need to get on with the job."

He warns for pragmatism and realism as the new system beds in:

"Performance in many parts of the system will be patchy at first. So we need to ensure public and political expectations are realistic. All those involved will make mistakes. Those leading the change need to be open-minded and flexible to improve policy and practice as we go. We are losing many experienced leaders. We need to ensure that as new ones emerge, taking on these challenges, they are given the support and cover they need to succeed, even if that means tolerating some difficulty along the way."

Source: ©NHS Confederation


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