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Thoughts on the White Paper detailing new legislative changes for the NHS

Dr Charlotte Augst

While welcoming the focus the government's White Paper could bring on integration, National Voices CEO Charlotte Augst warns 'the track record of achieving better, more equitable, outcomes for people on the basis of mergers and restructures of national bodies is pitiful'.

  • Communication and administration
  • Lived experience
  • Integrated care

We obviously need to engage more with the detail contained in the white paper on legislative reform of the health and care system. And we welcome that the Department of Health and Social Care and ministers signalled that they are keen to have this engagement with us and other groups representing the patient or citizen perspective.

Integration is clearly a goal of which we approve, particularly if it is understood as coordination of services. Our I Statements [INTERNAL LINK] show clearly that people often don’t experience services as connected and knowledgeable. But our engagement also clearly showed that people don’t have views on national structures.

The track record of achieving better, more equitable, outcomes for people on the basis of mergers and restructures of national bodies is pitiful. If you want to change how people access and experience care and what outcomes are created from this health service use, you have to start at the different end of the telescope. We suggest by listening to people. They will tell you what we need now [INTERNAL LINK].

Red tape and bureaucracy are easily identified as targets for our reformist zeal. While it is good to see that procurement and competition rules will be simplified, it is important not to forget three other points:

  1. In the days before competition and open procurement, the NHS didn’t exactly manage to pursue a razor sharp focus on better outcomes and experiences for people. So tinkering with those rules will again not necessarily force considerations about quality to the top of the agenda.
  2. The NHS can’t do it all alone. It needs the support, but also challenge from charities, social enterprises and even (deep breath) the private sector. Any assumptions that only if you have the blue logo can you improve outcomes for people is clearly for the birds.
  3. People using services aren’t interested in red tape challenges. They want services to be run well, and that includes being administered well. The misery of bad admin is something we are doing insight work on, and it is clear that in many cases the NHS should invest more, not less in its administrative processes and staff.

It is good to see that Public Health gets a mention, but we would like to see far more on what this Government will do, across all its responsibilities, to see through its commitment to extend healthy life expectancy by five years.

Again, this progress on healthy lives won’t be made by tinkering with NHS commissioning structures. It will take different jobs, houses, places and communities. And the #VCSE has a role to play across all of those agendas.

Finally, accountability. We do think one of the reasons outcomes are slow to improve and services often create low value for people is that those people and communities who need services can’t hold the system to account.

The old adage, if you aren’t at the table, you are likely to be on the menu, holds true for the governance of NHS bodies, and how communities and users can demand better.

So we want to see much more detail on how Integrated Care Systems in particular will be challenged and supported to work with, rather than on behalf of, the people who need health and care services to do better.

We hope the White Paper doesn’t confuse accountability with further centralisation (also for example with regard to inspecting councils …) – and one thing we have learned in the last 12 months is that better decisions were made closer to the issues, rather than in wood-panelled rooms in Whitehall.

In summary, for us the key question clearly is ‘how will all this make a difference for people who need health and care to do much better?’ We stand ready to interrogate the detailed provisions of this White Paper and then Bill to make this much clearer.

Everything else feels indulgent against the backdrop of the challenges that lie in store for communities and the health and care system itself.