Five years ago, independent healthcare such as the NHS underwent a seismic shift. Reforms ushered in by the then Health Secretary Andrew Lansley meant the end of increasing consolidation of organisations, resources and plans at the regional level under fewer but more powerful strategic health authorities. With SHAs (Strategic Health Authority) put to the sword, the system expanded rapidly, with new GP-led organisations created to drive up the quality of services by using free market disciplines of reward and failure.
Lansley’s tenure as Health Secretary ended after just two years. Views of his reforms vary. They were undoubtedly a huge distraction, and costly. The experience was lost and the new cadre of leadership took time to mature and gain confidence. With so many new organisations forming, demand for talent outstripped supply. Sharing of corporate expertise was no longer encouraged as competition, not cooperation, was now king. Boards and governance arrangements struggled to meet the demands of a rapidly evolving regulatory and policy environment and external communication was dominated by the technical, not the practical or aspirational.
On the flip side, the changes shifted focus back onto the local, with the NHS increasingly looking out rather than just up. Relationships strengthened between the NHS, local authorities and other partners. Perhaps this is why, five years on, under STPs (sustainability and transformation partnership) and the emerging integrated care systems, the system is consolidating again.
A powerful but unintended consequence of the reforms was that by creating so much rivalry, the NHS has now realised it is so much stronger working together. Competition has abdicated in favour of cooperation. Integrated services and shared budgets are seen as the way to meet increased demand, today’s health challenges, and the opportunities offered by expanded prevention, community services and technology.
This evolution will continue, but there remain serious challenges ahead. One of the most overlooked at times of rapid change is the importance of robust governance. Whilst patients and staff will welcome more joined-up care, ultimately the buck must stop somewhere. As cooperation increases and formal and informal alliances are made, leaders must make sure that they continue to have an effective line of sight of patient care no matter where or by who it is delivered.