‘Save expertise’: NHS Confederation

Urgent action is needed to retain good staff working for primary care trusts and to preserve organisational memory as the latest set of NHS reforms are worked through, the NHS Confederation has told the government.

In its response to the Department of Health’s white paper, ‘Equity and excellence: Liberating the NHS’, the management body says it supports the government’s objectives of empowering patients and involving clinicians more closely in decision making.

However, it says action must be taken to reduce the risks associated with the reforms. The white paper sets out plans to abolish strategic health authorities and PCTs and to devolve 80% of the NHS budget to GP commissioning consortia.

It also sets out plans to make all trusts foundation trusts, to involve local authorities in public health and social care and to give patients more choice and information about their options.

The NHS Confederation says the GP commissioning consortia will need expert commissioning support and argues that much of that expertise already exists within PCTs.

It adds: “We believe the government should put in place, as a matter of urgency, an effective human resources framework to ensure that we do not lose important skills and expertise during the transition period since it will be difficult and expensive to rebuild it.”

The Confederation also calls for the Department of Health to urgently review which management responsibilities it does not want to continue, so savings can be made immediately.

Its response also says that clarification should be provided as soon as possible on what functions consortia will be expected to deliver, on management cost limits and on the creation of a clear accountability framework.

Nigel Edwards, acting chief executive of the NHS Confederation, said the government needed to address “a significant list of uncertainties” about how the new system will work.

He added: “Ministers also need to ease the very deep worries that people feel about the transition.

"This is the area where people’s concerns have been greatest because there is a real danger of failures in quality of care or finances.

"We are about to embark on a hazardous journey at a time when resources are highly stretched. The risks are very real indeed.”

The Confederation makes 40 suggestions for improving the new systems and proposes a ten point action plan for managing the transition.

While the NHS Confederation welcomes the shift from targets to measuring health service outcomes, its response also raises concerns about the practical implementation of this policy.

“We think that the white paper substantially overestimates the extent to which there is a reliable methodology for measuring outcomes that will be useful to providers, commissioners and patients," it says.

"It also underestimates the substantial cost of data collection, particularly if it needs to allow for the appropriate risk adjustment of outcomes that will be necessary if these data are to be clinically credible.”

The NHS Confederation further argues that the DH is over-optimistic about the extent to which patients use the information currently available to them. It dismisses the idea that this is simply the result of poor presentation, saying this is not supported by the evidence.

The NHS Confederation said it hoped the government would tackle the issues raised in its response, either by making changes to national policy or by enabling local solutions.

The government’s three month consultation on its white paper closed on Monday, after a number of high profile professional bodies and think-tanks expressed concern about the thrust of the reforms and, in particular, the way in which they are being implemented.