BMJ 2014;348:g1935 doi: 10.1136/bmj.g1935 (Published 5 March 2014)
Page 1 of 2
News
NEWS “Labyrinthine” commissioning is barrier to change, says NHS expert Gareth Iacobucci BMJ
New competition laws and the fragmentation of commissioning responsibilities between clinical commissioning groups and NHS England are huge barriers to change in the health service, an NHS strategist has warned. Ruth Carnall, former chief executive of NHS London, said, “We have an absolute labyrinth of process that people need to wade through in order to get support for change. Many people live in daily fear of the judicial review that’s going to come along if they don’t follow the minutiae of the processes we’ve set up.” She was speaking at the NHS Innovation Expo in Manchester on 3 March. Carnall, who now works as an independent healthcare consultant to the NHS, added, “The reforms have led to even more fragmentation of that commissioning power and yet commissioners are supposed to lead change at scale.
“We have created an absolutely fearsome set of barriers which no one can credibly describe how we overcome.” She warned of a shortage of strong leadership to push through decisions that may prove unpopular with the public.
“Frankly, the number of people we’ve got with the experience and resilience to see these things through is few and far between,” she warned.
Speaking at the same debate, David Nicholson, outgoing chief executive of the NHS, warned that large scale reconfigurations to the way the NHS in England delivered services may take “years” to achieve, but he said that they must be pursued to ensure the survival of the health service. He said that the NHS was “at a fork in the road” and that “significant changes” to service delivery were required in order to meet the demographic and financial challenges ahead.
But Nicholson, who recently called for the number of acute hospitals in England to shrink to allow knowledge and resources
For personal use only: See rights and reprints http://www.bmj.com/permissions
to be centralised and used more efficiently,1 admitted that it would be tough to navigate the strong resistance to change from some local communities and politicians. He said that national politicians must support local clinicians to make the case for service redesigns, and he urged local medical leaders to look beyond the boundaries of their own organisation when changes were being proposed.
He told delegates that primary care needed to be strengthened and integrated with community care “at scale,” with a focus on better access and seven day working. He also called for services to be designed more around individual patient needs for those with complex conditions. “We have to make significant changes to the way we deliver services to patients,” said Nicholson. “Sometimes we talk ourselves into a place where we don’t think change is possible. But up and down the country, you can see how it has happened in practice. But it is difficult and it is tough.
“We need leaders who look beyond the boundaries of their own organisation. We need to make sure the arrangements put in place are much simpler. It can take several years. It takes many years sometimes.
“We need to make sure that nationally we make the case for change. Very often local people are left to make the change in isolation. We need to fall shoulder to shoulder with those people, and we need to tackle the politics of this. This is a matter of survival for the NHS.” 1
Iacobucci G. Number of acute hospitals in England must fall for NHS to survive, says outgoing chief. BMJ 2014;348:g1560.
Cite this as: BMJ 2014;348:g1935 © BMJ Publishing Group Ltd 2014
Subscribe: http://www.bmj.com/subscribe
BMJ 2014;348:g1935 doi: 10.1136/bmj.g1935 (Published 5 March 2014)
Page 2 of 2
NEWS
Figure
For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
Page 1 of 2
News
NEWS “Labyrinthine” commissioning is barrier to change, says NHS expert Gareth Iacobucci BMJ
New competition laws and the fragmentation of commissioning responsibilities between clinical commissioning groups and NHS England are huge barriers to change in the health service, an NHS strategist has warned. Ruth Carnall, former chief executive of NHS London, said, “We have an absolute labyrinth of process that people need to wade through in order to get support for change. Many people live in daily fear of the judicial review that’s going to come along if they don’t follow the minutiae of the processes we’ve set up.” She was speaking at the NHS Innovation Expo in Manchester on 3 March. Carnall, who now works as an independent healthcare consultant to the NHS, added, “The reforms have led to even more fragmentation of that commissioning power and yet commissioners are supposed to lead change at scale.
“We have created an absolutely fearsome set of barriers which no one can credibly describe how we overcome.” She warned of a shortage of strong leadership to push through decisions that may prove unpopular with the public.
“Frankly, the number of people we’ve got with the experience and resilience to see these things through is few and far between,” she warned.
Speaking at the same debate, David Nicholson, outgoing chief executive of the NHS, warned that large scale reconfigurations to the way the NHS in England delivered services may take “years” to achieve, but he said that they must be pursued to ensure the survival of the health service. He said that the NHS was “at a fork in the road” and that “significant changes” to service delivery were required in order to meet the demographic and financial challenges ahead.
But Nicholson, who recently called for the number of acute hospitals in England to shrink to allow knowledge and resources
For personal use only: See rights and reprints http://www.bmj.com/permissions
to be centralised and used more efficiently,1 admitted that it would be tough to navigate the strong resistance to change from some local communities and politicians. He said that national politicians must support local clinicians to make the case for service redesigns, and he urged local medical leaders to look beyond the boundaries of their own organisation when changes were being proposed.
He told delegates that primary care needed to be strengthened and integrated with community care “at scale,” with a focus on better access and seven day working. He also called for services to be designed more around individual patient needs for those with complex conditions. “We have to make significant changes to the way we deliver services to patients,” said Nicholson. “Sometimes we talk ourselves into a place where we don’t think change is possible. But up and down the country, you can see how it has happened in practice. But it is difficult and it is tough.
“We need leaders who look beyond the boundaries of their own organisation. We need to make sure the arrangements put in place are much simpler. It can take several years. It takes many years sometimes.
“We need to make sure that nationally we make the case for change. Very often local people are left to make the change in isolation. We need to fall shoulder to shoulder with those people, and we need to tackle the politics of this. This is a matter of survival for the NHS.” 1
Iacobucci G. Number of acute hospitals in England must fall for NHS to survive, says outgoing chief. BMJ 2014;348:g1560.
Cite this as: BMJ 2014;348:g1935 © BMJ Publishing Group Ltd 2014
Subscribe: http://www.bmj.com/subscribe
BMJ 2014;348:g1935 doi: 10.1136/bmj.g1935 (Published 5 March 2014)
Page 2 of 2
NEWS
Figure
For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
