Government and national bodies take charge of decision making as NHS crisis grows

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i658 (Published 03 February 2016) Cite this as: BMJ 2016;352:i658
  1. Chris Ham, chief executive
  1. King’s Fund, London, UK
  1. C.Ham{at}kingsfund.org.uk

Central controls will not be sufficient to restore financial stability and sustain performance

The financial crisis engulfing the NHS in England is leading to fundamental changes in how services are managed and where decisions are taken. These changes follow from planning guidance issued in December1 and letters on the use of additional funding issued in January. The language being used by national bodies emphasises control and compliance as concerns grow about deteriorating performance.

The last vestiges of the former health secretary Andrew Lansley’s ambitions to liberate the NHS by devolving responsibility for decision making have in effect been removed as NHS England and NHS Improvement increase their grip on commissioners and providers. The autonomy of foundation trusts has all but been eradicated, with all NHS providers required to achieve centrally set financial targets and no longer free to decide how to use their cash reserves, where these exist. For their part, commissioners have been required to produce plans showing how they will implement national priorities and have a long list of “must dos” to deliver.

Another fundamental change is the requirement for NHS organisations to submit five year sustainability and transformation plans by July. These plans will cover all the services provided …

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