NHS: Delaying the changes will increase, not reduce, the risk of chaos

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NHSBy Tim Swift

Last Thursday, I attended a “leaving do” for the Chief Executive and hundreds of other staff who are leaving Calderdale PCT.

Many of these are transferring to other organisations, as part of the changes to community health services already planned by the previous government. Others are moving on, taking early retirement or redundancy, in advance of the demise of PCTs and the introduction of GP commissioning.

This situation will have been repeated up and down the country. It’s why, in a marked reversal of “localism”, existing PCTs are being “clustered” for management purposes – so, for example, Calderdale is being linked with Kirklees and Wakefield.

Talking to some of the staff who are staying, it’s clear they are simply clinging to the hope of doing their best to deliver good outcomes with little sense of where they will be in the months ahead.

And we are relatively well placed within Calderdale. There has been strong GP involvement in the PCT throughout, and a clear plan to move to GP-led commissioning based on a single, Calderdale wide consortium. Many other areas have less developed plans, and conflicting views about the best future configuration.

According yesterday’s papers, with stories in both the Telegraph and the Independent on Sunday, it would seem that David Cameron is going to force his Health Secretary Andrew Lansley into a pretty humiliating climb down, with the legislation being slowed down and amended.

But this on its own is not enough. Andrew Lansley has already forced many of his changes through, using ministerial direction and pressure, in advance of the legislation. That’s why we are seeing a steady draining of talent, skills and knowledge from the system.

A delay alone will simply add to the confusion and uncertainty that is already hitting the NHS.

Cameron must not be allowed to get away with putting the blame on Lansley. He certainly should not be given any credit for a rethink. This was a huge initiative for the coalition, and if we are to believe Cameron’s claim that health is his main priority, then it beggars belief that he could pretend now that he has not been fully behind the plans.

The NHS is now facing planning blight as a direct result of incompetent government policy making, just at a time when it is also expected to implement huge efficiency savings. As problems grow, I suspect the outcome will be more, not less, central direction as the centre tries to take charge in the face of growing stories of local difficulties, from potential ward and hospital closures to financial overspends.

It’s going to be a very difficult year for anyone working in our NHS.

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