The NHS Restructure No One Is Talking About

When the Conservatives came into power, they undertook the biggest restructure of the NHS that had been seen since the foundation of the health service. But, another huge change is on the horizon.

Many said it was an unnecessary, top down change. However, for those taking an unbiased look at the old structure, you could see how broken it was. Management and clinicians were hugely divided, with spending and oversight often going in the wrong direction.

The NHS didn’t like it, but this change was, at least, a step in the right direction.

This restructure was all over the news, on the minds of every clinician in the NHS, and the butt of many jokes – not helped by a campaign pledge by the Conservatives for no top-down restructures. But, there is another restructure happening, behind the scenes, that no one is talking about.

Behind The Curtain

Have you wondered about the strangely opposing objectives of the Local Digital Roadmaps and the Sustainability and Transformation Plans?

Whilst the LDRs focus purely on technology, the STPs are designed to look at the entire health economy and what its key objectives should be, and how it can meet them – with technology forming an important part of the solutions required.

But, these STPs are not just a planning exercise. This is not about ticking a box – “yep, we made a plan.” It has been used as an exploratory exercise in joining up CCGs and localities into larger health economies.

The STP footprints are there for a reason. These are CCGs who can be, largely, aligned, or understood for the different priorities and requirements within their geographies.

STPs will form a new structure, much like the role fulfilled by Strategic Health Authorities.

We have seen CCGs merging over the last few years, and you will see CCGs within STP footprints merge together to form a single body.

This is already happening quietly, with Chief Executives of CCGs being given notices. These are all hidden in confidential plans, at this stage, because of the sensitive nature of the change.

Why Restructure Around STPs?

In many areas, CCGs have limited influence over Trusts, and can lack the buying power of larger organisations.

Joining together under the umbrella of an STP, means that the new, larger organisation is likely to be using far more services from a Trust, and so have larger influence over its decisions. It also means that, when going into procurement, the new organisation is likely to get better value-for-money, due to it being a much bigger customer.

It’s an evolution of the current model, rather than a big step away from the change brought in by the Conservatives. Patients and clinicians are still at the heart of the objectives, and management structures are there to deliver on and monitor performance towards those aims.

The more you look at the potential that these new super-CCGs can have, the more you realise this is a change for the better, and that keeping things quiet is a good way to allow this to happen smoothly.

Some of the STPs have been seen as shopping lists, which explains some of the multi-million pound investments asked for. But, these will be chopped down to size in further redrafts, under the supervision of NHS England.

Looks Familiar?

If you look at the size of the STP footprints, you’ll notice this structure looks rather familiar – especially, if you deal with Scotland, or Wales.

That’s right, they look a lot like Health Boards.

In Scotland and Wales, Health Boards have full ownership of healthcare in their areas. And what they say goes. If the Health Board wants to implement e-prescribing across the entire area – it’s happening.

England is lagging behind in the implementation of things like eRS, EPS, and SCR.

Scotland, however, has widespread use of its referral service, electronic prescription messaging, and emergency health record. And, they have had it for years.

The Health Boards are very powerful and they get the job done – whilst enjoying that they can learn from the mistakes committed by England, and implement everything far better. Leaving them plenty of time to laugh at England over some haggis.

Cultural prejudices aside, this Health Board structure has been tried and tested in our Celtic nations, and it seems like England is finally implementing this approach.

So, don’t be surprised if you suddenly start seeing STP footprints rebranded as Health Boards.

The NHS is quietly at work putting itself into a better position to deliver the kind of health and social care we need in the UK.


James Barton

James is a freelance writer and specialist in Digital Health. He brings his perspective as a leader within a reknowned supplier to developments within the healthcare technology industry.

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