Major restructuring could jeopardise NHS reform agenda, warns The King's Fund

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Government plans to carry out a major restructuring of the NHS could derail the health service reform agenda and place health professionals under severe pressure.

That was the view of The King's Fund in response to guidance published today by the Department of Health, which reveals plans to reconfigure the service and cut back on management and administrative costs.

The King's Fund chief executive Niall Dickson said:

'This represents a major structural reorganisation of the NHS over a very short period of time just when the health service is trying to get to grips with all the other major reforms it has been tasked with introducing.

'While many of the proposed changes outlined today are wholly sensible in themselves, it is the volume and pace of change that concerns us and whether or not the health service can cope with all that is being demanded of it. We're already seeing the huge financial strain that new reforms, such as patient choice and payment by results, are placing on the service and the last thing we should be doing is diverting the attention of managers and health professionals from this demanding agenda, as well as from improving services to patients.

'It's well established that organisations entering periods of restructuring become less effective. Reorganisations are a clumsy reform tool and seldom deliver the promised goals they were set out to achieve. While we agree there is further scope for savings to be ploughed back into front-line services, this is the wrong time to impose structural change.

'Another major concern is that today's guidance will not do enough to strengthen commissioning, which remains one of the biggest gaps in the NHS reform agenda. The government needs to get much more serious about commissioning but today's proposals put too much emphasis on primary care trusts to come up with all the solutions themselves. We know that unless commissioning is strengthened we're going to have continuing financial problems in the NHS, but this is not the way forward and we would like to see greater attention paid to this area. We need proper demand management incentives in the NHS and we're not going to get them unless commissioning is significantly boosted. This requires a more coherent vision from the centre than the one outlined today.'

Niall Dickson added: 'However, there is much to be supported in today's guidance. We recognise the need for the health service to cut back on bureaucracy and slim down its management functions. We also support moves to return commissioning responsibilities and budgets back to family doctors. This is the right way forward and will inevitably lead to a rationalising of the number of primary care trusts and strategic health authorities.

'A word of warning though is that we are seeing the creation of a more volatile market in the health service and that will require much in the way of managerial expertise to oversee the system in each area and ensure patients have access to a comprehensive range of services. Primary care trusts also have a vital role to play in holding to account GP practices that take up their own budgets and commissioning responsibilities, as well as effectively managing their local health economies.

'Finally, we want to see the process outlined in today's guidance to be a local one, where primary care trusts are encouraged to come up with configurations that work best for their communities. It's important that this is a real local configuration and not one that is pre-determined by national targets.'

Notes to editors

1. For further information or interviews, please contact the King's Fund media and public relations office on 020 7307 2585. An ISDN line is available for interviews on 020 7637 0185.

2. The King's Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through funding. We are a major resource to people working in health, offering leadership development programmes; seminars and workshops; publications; information and library services; and conference and meeting facilities