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Published 4 June 2018
“As we salute the NHS turning 70, an institution we have worked with since its foundation in 1948, it seems fitting to reflect on key events.
“Since DAC Beachcroft’s work with the first acquisition of a trust by a foundation trust, we have also helped around a third of Primary Care Trusts (PCTs) with their Transforming Community Services programmes and transition into Clinical Commissioning Groups (CCGs).
“It was satisfying to help streamline the processes, and even more so now we continue to work on the changing nature of collaboration and commissioning between health and social care and developing new care pathways.
“Over the last two decades we have seen much more collaboration and innovative thinking across the system. Legislatively, it can be hard to work as one, but organisations are finding ways to come together and we are seeing many positive changes.
“However, the NHS has never been as politicised as it is now. Nor has it ever been under the current intensity of regulatory scrutiny across quality, safety and financial rigour.
“As the NHS evolves (and continues to do so) we change with it, adapting with our clients. Key structural changes have of course been driven by legislation, enacting key policy decisions; however, a significant driver within recent transformation has been locally motivated innovation and cultural change, particularly in new models of care and within the patient safety agenda.
“In patient safety, for example, the Francis recommendations were a landmark; though in some ways the legislation that followed – such as the regulatory duty of candour – felt at the time like a hammer to crack a nut. A few years in, and many of us can see that the pressure created by placing candour within a regulated framework, perhaps hastened progress in achieving the cultural changes sought on safety.
“Alongside this the NHS has learned lessons from working with patients and families. We have seen these reflections, taken from both distressing and rewarding times, inform and develop how health leaders approach their services in 2018 and the way they work to improve safety and the overall patient experience in NHS services. Mapped alongside the strategic changes to care pathways, partnering structures in establishing new working relationships, changes in funding, and policy shifts within (for example) mental health services and digital health opportunities to increase access to NHS services, the NHS’s pathway of continuous evolution continues.
“We are truly proud to have been a part of the NHS and its outstanding journey over the past 70 years and look forward to the next 70.”
Talking to those who have held senior roles in the NHS during many of the last 70 years, it is clear that both cultural and legislation changes have impacted the NHS.
“While legislation can result in structural changes, it can be difficult to value what you are trying to achieve,” says Consultant and Chair of the PwC public sector health board Mike Farrar, whose previous roles include Head of Primary Care at Department of Health and heading the NHS Confederation. “When the politics align with what the politicians intend, the NHS can continue with what it needs to do, but when regulations are stacked against it, it will struggle.”
Yet it was not until the reorganisation of the NHS in 1974 that it “occurred to Governments that they could interfere in the NHS,” says Ken Jarrold, Chair of Northumberland, Tyne and Wear NHS Foundation Trust and who spent three years as the Director of Human Resources and Deputy to the Chief Executive of the NHS in England.
“Before 1974, the Government’s role was simply to provide,” says Jarrold.
“The introduction of health authorities created a direct chain of command for the first time,” agrees Stephen Thornton, a former head of health authorities, the NHS Confederation and the Health Foundation.
There were other long-lasting effects of the 1974 reorganisation. Former NHS Chief Executive and now Chair of the NHS Retirement Fellowship, John Rostill, says the NHS gaining responsibility for public health and local authorities for social care was “probably a compromise and that’s never a good way of developing a policy. Commissioners ended up on the back foot and Cinderella services were left behind.”
The introduction of the internal market and the purchaser/provider split at the end of the 1980s was another seismic time.
“It saved the NHS from right wing reforms,” adds Jarrold. “Without it Mrs Thatcher would have let the NHS be privatised.”
The Griffiths report of the early 1980s was also a key milestone. The report ended ‘consensus management’ and introduced general management in the NHS, resulting in a massive cultural change.
“It was the biggest change of all,” says Thornton.
But it is widely agreed that the overriding approach of central command and control has remained since 1974.
Jarrold notes that other attempts at giving the NHS further freedoms, through the establishment of trusts and later foundation trusts, have eventually seen them “whittled away”.
The Lansley reforms of the 2012 Health and Social Care Act had no effect in changing this and are widely seen at best as ineffectual and at worst damaging to the service. But it is widely acknowledged that there is little appetite or legislative time for further reform.
“The change work that is being done now is place based. It makes enormous sense and is being done without regulation or legislation, but it also needs adequate funding; you can only work with what you have,” says Farrar.
To discuss the issues raised in this article, please contact Nigel Montgomery on +44 (0)117 918 2321 or firstname.lastname@example.org.
+44 (0)117 918 2321
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