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NHS needs ‘fundamental change’, warns King’s Fund

The NHS is performing well, but a focus on the move to CCGs could undermine the ‘fundamental change’ needed to improve the service, a think tank has warned.

In its report on the coalition Government’s achievements in health policy, the King’s Fund warned there were ‘treacherous waters’ ahead and that organisational change was not enough.

The report – published today - said that there was a ‘dearth of evidence on the effectiveness of commissioning’.

It found: ‘Where GP-led commissioning has been tried previously, it has generally led to extended provision of primary care services.

‘The reorganisation of commissioning organisations may set back the development of commissioning rather than advance it – at least in the short term.’

The report comes after the NHS Commissioning Board revealed quality premium payments for CCGs are likely to be based on a set of five to 10 measures drawn from the NHS Outcomes Framework.

But the King’s Fund found that there was also ‘a risk that too much is expected of financial incentives and that these are not aligned to the objectives ofthe system’.

 It adds: ‘The expectation is that commissioners will commission for outcomes, although it is not clear what this will mean at a practical level in terms of the contracts and payments used to pay providers.’


The report also said there was a risk the structures being put in place by the NHS Commissioning Board would recreate ‘the grip of SHAs over PCTs’.

It concludes: ‘The Government has also claimed to strengthen the democratic legitimacy of commissioning decisions by creatinghealth and wellbeing boards, though these bodies will have little direct authority over CCGs.’

Anna Dixon, director of policy at The King’s Fund, said: ‘The NHS is continuing to perform well but there are treacherous waters ahead.

‘Neither competition nor commissioning reform alone can be relied on to make the improvements needed. Fundamental change will be required to address the challenges of the future as the population ages and health needs change.’

Commenting on the report, Mike Farrar, NHS Confederation chief executive, said: ‘A growing number of organisations are finding themselves being pushed towards a cliff edge and tough decisions need to be taken if they are to recover their financial footing and deliver better care.’