Cooperation and creativity in the NHS

By The Guardian | February 25, 2018

Readers discuss accountable care systems, health co-ops, hospital real estate and the benefits of regional planning.

The gist of Polly Toynbee’s argument is obviously right (The NHS needs cooperation, not competition, to pull through, 19 February). She may not, however, know that here in Cornwall there is an effort being made to introduce an accountable care “system” (ie not “organisation”), which reassuringly does boil down to the sort of integrated care partnership that she and the King’s Fund promote. But there is still vociferous opposition to the plan from local activists and from some doctors, clearly because of the fear of privatisation. I can see that this unnerves local politicians, who fear that they will be stuck with doing their own NHS rationing if it goes through. You just can’t win.

All of us who have followed NHS policy and practice over recent decades must wake up to the fact that the NHS is now a monster: neither smart chief executives nor driven politicians have found it possible to manage as a single entity. It was actually impossible to do this when Aneurin Bevan said he wanted to hear the sound of a bed pan being dropped; and we are still stuck with that centralising mentality. Advertisement

The secretary of state and his department should concentrate on preserving, supporting and regulating our basic entitlement to care, and empower the local NHS to develop. Those who will claim that this will lead to a postcode lottery of service provision should pay attention to the variations we already have all over the country. These have not been prevented by central control – and are at the expense of local innovation, and of enthusiastic patient engagement, which offer better prospects.

Peter Thistlethwaite Saltash, Cornwall

Integration within the NHS and between the NHS and local government is already happening in many areas and is bringing benefits to patients. NHS England’s decision to delay the use of the controversial ACO (accountable care organisation) contract provides an opportunity for them to explain what the contract adds to existing ways of integrating care, and indeed whether it is needed at all at this stage. In the meantime, NHS leaders at a local level are finding ways of using existing flexibilities to make progress. Guardian Today: the headlines, the analysis, the debate - sent direct to you Read more

Ultimately, amendments to the 2012 act will be needed to align current developments with the law, as the Conservative party’s 2017 election manifesto recognised.

Chris Ham Chief executive, The King’s Fund

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