PwC is calling for local areas to be given the power to raise funds for their regional health service. New research finds that 70% of NHS staff in England do not understand the role of the national bodies in the healthcare system. The report calls for the government to clarify the roles of these bodies and move to a more devolved system where local areas are given more accountability and responsibility.

  • 70% of NHS staff in England say they do not understand role of national bodies
  • Two in three say divide between health and social care is bad for patients<
  • PwC report calls for merger of national institutions and new revenue-raising powers for local services

The report also calls for Health and Social Care to be brought under one department, away from the current system where social care sits with the Department for Communities and Local Government (DCLG). The research shows that staff are also confused by the division between health and social care in the healthcare system.

PwC’s latest report Redrawing the Health and Social Care Architecture, looks at the future role of national bodies in the healthcare system and calls for radical devolution to local areas. PwC surveyed more than 1,000 NHS staff and over 2,000 members of the public in England to gain the views of both those within and outside of the system. The results show a high level of confusion and frustration across the board with the majority of NHS staff believing the entire system should be reformed:

  • 71% of NHS staff in England want the healthcare system reformed;
  • 66% of NHS staff in England are frustrated by the division between health and social care.

To address the confusion between the roles of the national local bodies in the NHS and the system overall, PwC makes a series of recommendations in the report:
Short term:

  • Create a new care management board or merging NHS Improvement and NHS England –  to simplify the structure of the current health and care system
  • Clarify and coordinate the work of local institutions
  • Delegate responsibility for managing the health and care system in their areas to Sustainability and Transformation Planning (STPs)
  • Clarify the role of  The Department for Health and The Department of Communities and Local Government in healthcare.

Longer term:

  • Shift accountability to the local level by allowing Regional Care Groups to evolve into democratically accountable bodies and have responsibility for commissioning health and social care.
  • Give local democratically accountable leaders powers to raise additional funds through taxation.
  • Shift control of healthcare to local areas

The report frames a vision in which the system remains a national service, where standards and majority of the funding is determined at a national level. However increasingly this balance of power should be devolved so local areas have greater responsibility and accountability, the report suggests. This will require phased changes to the architecture of the NHS. Alan Milburn, former Health Secretary and chair of the PwC Health Industries Oversight Board, commented:

“Despite the best efforts of its leaders to make it work, the current national architecture is confused and complex. The artificial divide between health and social care makes as little sense as the division of labour between a myriad of national bodies.  

“Organisational change is always a risk but without it, the move towards integrated local care systems will be undermined.  

“This report sets out a long-term reform agenda towards an NHS in which the balance of power moves from national to local level where services are delivered.”  

David Morris, PwC partner and author of the report commented:

“Our research highlights a persistent underlying sense of confusion about the roles of national bodies in the NHS, coupled with frustration over the division between health and social care. Evidently there is growing appetite for reform.

 “It is essential that this debate does not fall to the bottom of the pile and I hope this report is a welcome addition to the discussion and helps point to some much needed solutions to the growing problems the NHS faces.”