NHS Reforms Poised to Reverse Cameron-era Changes

4 Mar 2021

On 11th February 2021, the Department of Health and Social Care published the White Paper, ‘Integration and Innovation: working together to improve health and social care for all’. According to Health Secretary Matt Hancock, the reforms will restructure the NHS in England to facilitate close working of health and care services, allowing them to focus, ‘on the health of the population, not just the health of patients.’ Despite its title, the White Paper contains little on social care. On that issue, Hancock states that the Government is ‘committed to the reform of adult social care and will bring forward proposals this year’.

The current system is borne out by those who feel that they have the energy and strength to seek legal advice when issues arrive with medical care. Claims take a long time. It is a complex process and mentally exhausting for families.

The same mistakes are happening on a regular basis at some maternity units which means lessons are not being learned.  Maternity units are struggling due to pressures of workload and staffing issues, this leads to poor medical care and mistakes being made on a regular basis and there is no time to reflect on these mistakes to ensure that they do not happen again.  Skill set is also often not fit for purpose so that the risk of harm is often continually high. Training needs are not being met and morale in maternity units is low which means that the care provided is not optimum.

Lansley reforms

Nine years ago, David Cameron’s Health Secretary Andrew Lansley, introduced sweeping reforms to the NHS, which were enshrined in the Health and Social Care Act 2012. The aim was to decentralize the NHS and to provide local groups with autonomy over spending and commissioning health care. In the shake-up, Public Health England and GP-led Clinical Commissioning Groups replaced Primary Care Trusts as organizers of local services.

The reforms were opposed by Professional Unions and the Royal Colleges. They were viewed as an attempt to commercialize the NHS, as commissioning groups encouraged competition and reduced costs. Unfortunately, to make savings, services became fragmented and some were lost entirely. Furthermore, the path of accountability was unclear, the burden of bureaucracy increased, and competitive tendering allowed private firms to undercut the NHS. Staff demoralization was also a common complaint.

Lansley reversed

The 2021 White Paper reverses the unpopular Lansley Reforms. While under Lansley national bodies had a large degree of autonomy, the Secretary of State for Health is now back in charge. This means that the Government will have ‘enhanced powers of direction […] to ensure that decision makers overseeing the health system at a national level are effectively held to account’. The Government will take back direct control from organizations and regulators such as Public Health England and will directly control NHS England. Clinical commissioning groups will be replaced by Integrated Care Systems and it is anticipated that health services across the board will work more closely together as a consequence.

The Lansley tendering rule will also be scrapped. This rule saw providers and private companies compete to win contracts to run services, a scheme that made it difficult for local groups to pool their resources. Now, the NHS and local councils will collaborate with resource allocation and service provision, with more focus on GPs, hospitals and social care services working to improve patient care. The role of the private sector within the NHS will be reduced as a result.

Cutting red tape

The White Paper also aims to remove unnecessary bureaucracy, which will empower local health services to provide targeted improvements in the delivery of public health and social care, addressing local issues and targeting local need.

Sir Simon Stevens, Chief Executive of the NHS said, ‘Our legislative proposals […] provide more joined-up care, less legal bureaucracy and a sharper focus on prevention, inequality, and social care, […] building on the past seven years of practical experience and experimentation across the health service’.

Optimism mixed with caution

The proposed changes were greeted with mixed reviews:

Gail Cartmail Assistant General Secretary of Unite said, ‘[if this reform] heralds a roll-back of NHS privatization, this is to be greatly welcomed. The 2012 Health and Social Care Act is recognized as a disaster, fragmenting services, and giving too much sway to the profit-hungry private sector’.

However, Labour Shadow Health Secretary Jonathan Ashworth noted, ‘Boris Johnson must explain why a reorganization in the midst of the biggest crisis the NHS has ever faced, is his pressing priority.’

Indeed, no matter whatever reforms are anticipated, they must be supported by appropriate staffing and adequate funding, otherwise they will be perceived as primarily cosmetic and of little practical value to the workers and users of the NHS.

Stephanie Prior, Clinical Negligence specialist


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