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Do you understand the new structure of the NHS?

_mg_4712This month we set Chief Executives of local carers’ organisations a test: do you understand the new structure of the NHS? Does it make sense in your local area?

As part of the test, we asked them to look at the slides produced by The Nuffield Trust on the old and new NHS structures and what has changed.

The slides show the main changes to management, accountability and funding structures resulting from the Health and Social Care Act 2012.

In our latest blog, one of the network Chief Executives reflect on how the different parts of the new system – Clinical Commissioning Groups (CCGs), Health and Wellbeing Boards, Public Health and HealthWatch – are working together in her area.

She says that things are still confusing and that there are still lots of challenges to address as the reorganisation of the NHS continues.


I have studied the slides and whilst they are not difficult to understand, they are unnecessarily complicated and it’s interesting that the different bodies appear to work in isolation of each other. There doesn’t seem to be anything between each body, leaving plenty of opportunity for conflicting and duplicated work. Also I’m not sure whether the local structures are clear.

Some developments but more engagement needed

The Health and Wellbeing boards have identified some priorities, and they have met with some of the partnership boards (including voluntary organisations) to detail how they want to work. They have identified carers’ needs as one of their priorities – that said, they are not engaging with carers’ centres and at the moment details of membership, or approaching members of the boards to raise issues, is shrouded in secrecy. This is my experience — there may be others who think differently but I have yet to find them!

In my area there is a partnership board, which is a partnership of statutory and voluntary sector organisations, who meet every couple of months to discuss the headline issues and the Director of Public Health usually attends these.

The last two meetings have been cancelled for one reason or another, and it is at times unclear what the purpose of the meetings are as each participant appears to have their own agenda. This is particularly noticeable just now as contracts are changing and the council are opening up services for tender.

Are different parts of the structure working together?

Whether or not the Health and Wellbeing Boards are getting involved with new CCG arrangements is another unknown. This includes whether they are any good at filtering out what they are involved with and any anticipated outcomes.

There are plans for the CCG’s in my area to work with the local authority. However, how they work is not made clear to either stakeholders or wider partners in general.
There is almost an air of secrecy around who works with whom and to be honest I do not think this is entirely the fault of the CCGs. Our local authority have not been proactive in informing the communities that they serve how they plan to work with the CCG’s and what their joint priorities are, or indeed what conflicting priorities exist.

I’m guessing the Public Health are engaged, but again: what their input is, what any anticipated outcomes are, how they are working with the wider community and with the CCG’s in particular, has not been communicated.

It feels at times as though these bodies (I can’t really call them partners at the moment, because there is very little real partnership taking place) are shrouded in the Harry Potter cloak of invisibility. It is really confusing!

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July 26, 2013 - Posted by | Health, Uncategorized | , ,

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