2 days ago
So much is still unanswered about NHS reform
Given we have known for a good while that Labour thinks the way to save the health service is to move care out of hospitals and into the community, you might have expected today's NHS ten-year plan to explain how the government is going to do that. The preventive agenda is not a new idea that needs explaining, it's been around for the entire 77-year history of the health service. The problem, therefore, is not the lack of an idea, it's that reform never actually happens. The important and urgent priorities of waiting lists and emergency units always end up dominating, and the neighbourhood health centres, walk-in clinics, polyclinics or the 'health centres' set out in Labour's original plan for the NHS under Nye Bevan, end up coming a distant second, if at all.
We do not know how neighbourhood health centres are going to work with GPs, for instance, or how they will be incentivised to move into the centres. GPs are famously resistant to change, whether structural or more physical: Alan Johnson told me that the only way he could get them to move into modern premises was to threaten them with a polyclinic being built in their area, and then they would suddenly up sticks and modernise.
It turns out that we are to be kept waiting a while longer for the details of how ministers expect the NHS to achieve the big changes set out today. The document we should apparently have all been excited about was the NHS Planning Guidance, which is being published earlier than usual this year in order to make implementation faster. A delivery plan in today's document would have, apparently, just been for show rather than anything more meaningful.
There are serious changes in the operating models for NHS trusts, including incentives for high-performing providers. They will be able to reinvest surpluses, and given more control over a health budget for their local population which they must commit to shifting from hospital to community. Patients are to be given more power, and more than 200 bodies or entities are being scrapped. The rationale behind Healthwatch, for instance, being scrapped, is that listening to patients should be 'core business' rather than a niche enterprise. And the rationale behind abolishing so many parts of the NHS structure – including, of course, the end of NHS England as a separate organisation – is that the system is too centralised.
The plan was much delayed: it was originally supposed to be published 'in the spring'. For once, it was not rows about funding that held it up: though both Keir Starmer and Rachel Reeves repeatedly asserted that there would be 'no more money without reform', they also repeatedly announced more money without reform. Now, we have money and reform, but not enough evidence that the latter can actually happen, or that the former will make its way to the right places.
