THE NEED FOR FURTHER REFORM OF THE NHS

Many of us remember the restructuring that created a new body, NHS England, to run the health service, set up new regulators, to replace primary care trusts with clinical commissioning groups (CCGs) led by GPS, to organise local services, and which handed responsibility for citizens' healthy lifestyles  over to the town halls. 

Then in 2015, health visitors moved into local government as well, to complete the transfer of public health from the NHS to local authorities.

That was the change program legislated for in 2012 and implemented over four years to 2016.

 

 The vision was of a health service fit for the 21st Century. The key belief behind these root and branch changes was that greater competition in the NHS would make it more efficient and responsive. 

 But by 2019, competition as a driver of improvement was being rethought. The NHS' Long Term Plan argued that cooperation was now key. We needed a joined-up NHS.

Thus was born the integrated care systems (ICSs), created over the next two years, to 2021. An Integrated Care System. ICS is - as the name suggests - a partnership bringing together hospitals, CCGs (the GP-led clinical commissioning groups that organise local services), local authority community services, and the charities, to all work together. 

For example, after a fall, an elderly person might be hospitalised; then on leaving hospital there will be a four or six week program of home care organised by the LA social services; possibly physio; and a charity might be requested to provide some social life until the person can out and back into the community.

 This integration is necessary because an ageing population requires multiple different and coordinated services to work together, sharing staff, skills and records. Such are the complications brought on by aging compared to simple health issues faced by youth. 

 Evidently, the initial funding provided is no longer sufficient.

 The job now is to further join up and share the back office support services across regions and with office automation making managers more productive, many senior and middle positions can be "cancelled" for real.

And when we remember back to the beginning of the NHS after the last war. It was originally thought that once everyone was through the new cattle dip, once everyone's health had been fixed, there'd be little need for an NHS. It would all just be low-maintenance.

Little had we imagined how the demographics would change; nor could we conceive of the advances in medical science and possibilities for re-engineering the human body.

End

14 Sep 2021