New NHS Confed report shows greater local freedom needed  

The NHS long-term plan must help bring about a “breakthrough” in the development of local health and care systems by allowing them greater freedom and minimising central control, according to the NHS Confederation.

The Confederation is calling for action to remove the barriers to effective local system working.

It follows a survey of Confed members which found that:

•           Six in ten leaders (61%) agree that sustainability and transformation partnerships (STPs) and integrated care systems (ICSs) represent the right approach for partnership working between the NHS and local government.

•           But the vast majority of respondents considered that only moderate progress (44%) or a little progress (42%) had been made in implementing the system working approach set out in the NHS Five Year Forward View

•           When asked what would make a difference, local leaders identified better local partnership working, improved engagement with staff, patients and communities, more effective local governance and a more supportive oversight regime.

Based on the findings, the NHS Confederation is calling for the long-term plan to:

i.              Make support for effective local leadership and relationships a priority

ii.             Focus attention on the key factors that will allow local improvements to health and social care services

iii.            Shift the focus of regulation from performance management to improvement support

iv.           Support local systems to strengthen ownership in their communities of the long-term plan vision

NHS Confederation chief executive Niall Dickson said: “We recognise we are calling for increased freedom for local systems at a time when the health and social care service faces significant challenges – and that this may feel counterintuitive.

“But if the logic of the Five Year Forward View and the STP/ICS movement is that the serious systemic problems facing the service will only be addressed via close partnership working at a local level, it is vital every effort is made to make these local approaches successful. Otherwise, we risk stifling local solutions by excessive top down control.”

But he added that this call for greater freedom comes with a quid pro quo. He added: “For this to work, of course local leaders from within and beyond the NHS will need to implement new ways of working, embed local accountability mechanisms and involve staff and the wider public as services transform.”

Jane Milligan, Senior Responsible Officer for the East London Health and Care Partnership, said: “In North East London we have made some real progress in partnership working over the past two years, but strengthening this further is key if we are to accelerate our local integrated care development and tackle key challenges such as workforce and prevention.”

Sir Andrew Cash, Chief Executive System Lead of the South Yorkshire and Bassetlaw Integrated Care System, said: “The long-term plan is eagerly anticipated as it marks another ten-year commitment on the direction of the NHS.

“In doing so it also acknowledges a commitment to the leadership direction of travel which is for health and care organisations and partners to find a way to work together for the public good. Most importantly though we are all going to have to address the issues of health inequalities, and tackle over a longer term the social determinants of health. It’s potentially a great step forward.”

Wendy Saviour, Managing Director of Nottingham and Nottinghamshire ICS, said: “Nottingham and Nottinghamshire have a long history of collaboration and we will continue to build on these foundations to help us deliver positive change and help people be treated and cared for at home, or as close to home as much as possible.

“Now more than ever we need to be able to work across organisational boundaries to put patients at the heart of decisions around health and social care. We welcome the plan and the challenge for our partnership is to ensure that we use the resources we have to provide the most efficient and effective care for local people.”

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