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Lost in transition: room for improvement as “new” NHS takes slow steps in right direction

David Cameron

Many of us will have had a hard earned rest over the summer, perhaps a trip to the seaside, a good book and some time for reflection.

Our local bloggers — hard-working Chief Executives of local carers’ organisations part of the Carers Trust Network — have been reflecting on the on-going changes in the NHS.

Find out how things are unfolding for this month’s blogger who says that whilst there are still lots of challenges, there are positive developments too…


The overall structure of the NHS is clear to me but the detail and practicalities are less clear. For example the actual working relationships between the CCG, Public Health, HealthWatch, Public Health England and the Commissioning Support Unit all feel really unclear. There was a lot of hype around the change but actually, we are talking to the same commissioners. In some ways it feels like nothing has changed.

What’s working well?

CCGs have done lots of work to get out there, especially the GPs and leadership team and are presenting themselves as a new and public facing organisation ready to truly consult the population on what they want. This feels exciting.

We have been consulted on the Health & Wellbeing Strategy and Joint Strategic Needs Assessment (JSNA) which was very positive. This is being done concurrently to setting up all the organisations though!

The main challenges

The organisations seem small in terms of number of people and this is having an impact on how we can communicate with them. Additionally, the big expectation was that GPs would be available to talk about all commissioning, service planning and design, but we are talking to the same commissioners, with basically the same plans.

In many ways it’s a story of continuity rather than radical change. But this could of course change over time.

It all feels really challenging on the ground, from changes in IT systems, to offices, to big expectations being shoe horned on to a complex system that already exists!

It also feels like we often hear “that’s something we’re working through”.

It has been surprising how slowly some of the organisations have been setting themselves up. They say that they have only had 3 months since 1st April 2013, but actually there was a long lead in but it seems that the funding, people or support wasn’t available to do the work required.

Variation and a lack of clarity

Health and Wellbeing Boards are very different in the two areas. One feels more progressive and open and we even have a place for carers on the board. However this is under the guise of two places for HealthWatch, and one for carers. It is mostly a very small group of statutory representatives sat around a pretty closed table. Having said that, the demands on the Health and Wellbeing Boards feel immense.

Silence from some parts of the structure

HealthWatch is not fully up and running and again, although the national policy sets out how HealthWatch is different to LINKS, locally, it is unclear how HealthWatch will fit with the patient and public involvement that already exists.

NHS England’s regional office has been silent and given that they hold the contracts with the GPs, it feels they are an important stakeholder who we are, as yet unable to engage with.

Finally, Public Health has been the most silent in our experience. But as ever we are hopeful that all the parts of the system will start to come together and the conversation about how best to support carers will take place.

What do you think? Tell us what’s been happening in your area over the summer…

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September 3, 2013 - Posted by | Health | , ,

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