King's Fund discussion paper

Citation

(2002), "King's Fund discussion paper", International Journal of Health Care Quality Assurance, Vol. 15 No. 4. https://doi.org/10.1108/ijhcqa.2002.06215dab.006

King's Fund discussion paper

King's Fund discussion paperKeywords: NHS management, Reform, Better care

The start of the year was marked by new ideas about how the NHS should work. The BMA discussion paper is reported above and, in January, the King's Fund also published a discussion paper, which claimed that radical changes are needed to the way the NHS is managed.

The paper, The Future of the NHS, is based on the work of a group of experts from health and other sectors, chaired by Lord Haskins, chairman of the Better Regulation Taskforce. It argues that the NHS provides a good service in many ways, and that changing the way it is funded is not the most important task facing the government. However, it proposes three fundamental reforms of the way the NHS is managed:

1. 1.

   At the national level, legislation is needed to set up a corporation to manage the NHS at arm's length from the government. The corporation would have responsibility for allocating funds across the NHS, regulating health care and setting standards for services; while the government would provide funding and control health policy.

2. 2.

   Locally, existing NHS health-care providers should be re-established as new types of not-for-profit organisations with strong local accountability. They should have complete control of how they use their assets but remain publicly owned and work to national standards of care.

3. 3.

   At all levels, patients' views should have a more direct impact on shaping and developing services. For example, patients should be given more choice about how their own health care is managed, including where, how and by whom they are treated.

Lord Haskins said: "The NHS is not in crisis. It is not on the verge of collapse. But it does suffer from excessive political control, too much centralisation of power, and a lack of responsiveness to patients.

"Given sufficient funding and staffing, the NHS can provide the world-class service the public demands. Our approach to reform, implemented carefully over time and backed up with legislation, would give the NHS the best possible chance of meeting its ambitions."

King's Fund chief executive, Rabbi Julia Neuberger, said: "The Government has said that it wants to devolve power within the NHS, and has begun to do this in some cases. It is vital, however, that decentralisation happens across the service, not just in the best NHS trusts, and that it is protected over the long term.

"The whole of the NHS should be freed from political control of its day-to-day workings. Local NHS organisations should be able to manage their assets without interference from the centre and without the constant threat of reorganisation.

"They should be accountable directly to the people they serve, both locally and through Parliament. And they should be able to offer patients genuine choices about how they are treated."

RCN General Secretary Dr Beverly Malone, commenting on the paper, said: "The paper contains some interesting ideas, but the key priority at the moment has to be recruiting and retaining enough nurses and other health-care staff to deliver the high quality services patients deserve. Until NHS capacity is significantly improved, these new proposals, whilst stimulating debate and dialogue, will not be able to make meaningful differences for patients."

She commented that the RCN supports improving patient involvement in the NHS and decentralising decision making and reducing bureaucracy, but much more detailed debate is needed to tease out what these proposals would mean for patients, nurses and the public.

Professor Sir George Alberti, President of the Royal College of Physicians, said: "This report is interesting but sadly conservative in tone – it presents old ideas in new language and is not sufficiently radical. It still does not deal properly with local choice versus national standards, and does not tackle the biggest barriers of all – the divide between primary and secondary care, and the professional barriers to change. We need a real paradigm shift in thinking about the NHS, and this report does not provide it".

The discussion paper, The Future of the NHS, can be downloaded in pdf format from the King's Fund Web site at: http://www.kingsfund.org/eKingsFund/assets/applets/future_of_NHS.pdf, or contact the King's Fund bookshop. Tel: (44) (0) 20 7307 2591 for a free copy.