Exploring the role of national bodies in enabling and supporting the delivery of local health and care services
The health and care system is rightly a source of national pride, but the service today is under significant financial and operational pressures, both of which are set to increase. These pressures are felt throughout the system, from the patient and clinicians on the frontline, right through to the civil servants and politicians in Whitehall and Westminster.
Over a six month period, we researched what the public and staff working within the NHS think of its national architecture and explored what changes were required to better support local systems in delivering sustainable services in their areas.
“To use a sporting analogy, the role of national bodies is to set the rules including the shape and size of the pitch. It is not their role to referee every game or, worse, to play. What they do shapes the game that is played and the degree to which the crowd thinks it is successful”
The current national architecture of the health and care system is a complex middle-ground between central control, devolved decision making and a market-based approach.
There is, and has always been, a tension between the national and the local in health and care. As a result, there has been no consistent answer to the question of where public accountability, financial responsibility and operational control should best lie in order to deliver the services people need at a cost acceptable to the taxpayer.
During the course of our research we identified five areas for improvement that together add complexity, lead to duplication, and frequently hinder the progress local leaders are seeking to make. These are:
The national system is really confused at the minute and we’ve got lots of people working in other people’s territories, filling space they shouldn’t fill, and generating work and confusion, at a national and local level, so we need a very serious tidying up process.
We propose a two-stage approach to redrawing the national architecture, aligning with the journey that the health and care system has begun:
We are not so naïve to think that what we propose is a ‘silver bullet’ solution to the challenges facing the health and social care system. Indeed, there is much to be done at a local and national level to develop more personal, integrated and digitally enabled services and more empowered service users.
The new system we envisage will be a national service, in that its standards and the majority of its funding will be determined, as they are now, at the centre. But increasingly the balance of power would move towards local areas as they assume greater accountability for the financing and control of services.
Establishing this new system will require carefully phased changes to the architecture of the system and will take time to enact. By setting a firm direction of travel now policymakers can provide a clear roadmap of change. That in itself will help bring greater certainty to the care system.
Our research on health and care architecture was conducted over a six-month period and drew from a wide range of sources, including:
Our work has been overseen by a Steering Group which has offered views on the issues considered, suggested avenues of investigation, and challenged the analyses and conclusions developed throughout the course of the research.
Membership of the Steering Group comprises:
We would particularly like to thank all the members of the Steering Group for their time, energy and advice throughout this process, and remind readers that the conclusions reached and views expressed in this report are those of the authors only.