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!
We know that the moral and financial arguments for supporting carers are clear – without support, taking on a caring role can mean facing a life of poverty, isolation, ill health and depression. For the person they care for it can mean costly hospital or care admissions if the caring relationship breaks down.
Our Network Partners have to work with a whole range of commissioners – local authority and NHS – to keep themselves viable. In recent years PCTs have had responsibility for commissioning services to support carers and with our Network Partners we have made the case nationally and locally as why support for carers should be prioritised.
However on 1 April this year, the new commissioning structure in England came into place, replacing PCTs with new Clinical Commissioning Groups.
Many of our Network Partners have told us that this change is proving difficult for them and that it differs radically from place to place. In some areas the situation has stayed fairly stable and familiar faces remain, whereas for others, CCGs are undertaking reviews of local services commissioned by the NHS and long established contacts have gone.
To support our Network Partners make the case to their local CCGs for commissioning well for carers, and in some cases start talking to new commissioners about carers services, Carers Trust has produced Commissioning for Carers: Key Principles for Clinical Commissioning Group.
The NHS reforms not only changed local commissioning systems but also brought in new accountability arrangements which means that there are no longer specific performance targets or rules for investing in carers services. This makes it more difficult to hold the NHS to account locally for what it commissions for carers.
The NHS Mandate sets out the Governments priorities for the NHS and key areas where it wants to see improvements by April 2015.
- Preventing people from dying prematurely
- Enhancing quality of life for people with long-term conditions
- Helping people to recover from episodes of ill health or following injury
- Ensuring that people have a positive experience of care
- Treating and caring for people in a safe environment and protecting them from avoidable harm.
Commissioning for Carers: Key Principles for Clinical Commissioning Groups demonstrates to CCGS how supporting carers can help meet these key areas for improvement and led for savings across the NHS.
We know that CCGs across England are under enormous pressure to meet financial targets and the key priority areas for improvement.
Commissioning well for carers is in all our interests, including CCGs, as it benefits the people being cared for, reduce overall spending in the NHS and can help commissioners meet required their outcomes. Let’s hope that CCGs are listening.
The latest contribution for our blog series Lost in Transition? How carers’ services are navigating the new NHS is from the CEO of a large Carers Centre in the south of England. In it they reflect on the impact of recent restructuring on NHS staff and how changes are resulting in a lack of continuity and knowledge about carers’ issues...
The new NHS has arrived and in many respects this month’s NHS feels no different to last month’s. For carers, the impact of the most significant NHS changes since 1948 could take many months, or even years, to become apparent.
But for those of us working with the NHS—as commissioners of our services and as partners in the delivery of support for Carers—the changes are already apparent.
The first appearance of change was in the response of NHS colleagues. Staff working in and with the NHS are used to change. For some careers are measured not in years or promotions, but in restructures and cycles of change. A hardy few wear the number they have survived as a badge of honour, but even they have been going around in recent months with a dazed look that says “no, this one really is different”.
The second appearance of change has been in the sudden rush of business that absolutely had to be concluded by the end of March. Staff who have been in limbo for months getting to grips with new briefs, partnerships and responsibilities in weeks. If only it had been the other way round: weeks of uncertainty followed by months in new jobs with adequate time to prepare. And any number of contracts, policies and strategies to be reviewed, cancelled, revised, updated, or if all else fails extended on the grounds that ‘business as usual’ will do for now.
For us, at least until recently, most business to do with carers has fallen into this last category—neither big enough (in monetary terms) nor important enough (in commissioning terms) to appear on the CCG radar. But this continuity is only temporary; the sudden rush of business has been accompanied by a massive loss of history and knowledge as staff have moved on to new roles or pastures and this presents us with our greatest threat.
Whilst review of all services is inevitable, the loss of continuity sees this being led by commissioners who start with little understanding to inform their thinking.
Commissioners with little experience of carers needs and strategies, reviewing services they have not encountered before, alongside carers and providers who are strangers to them if not to each other. Some will tread carefully, take a long-term view, and ensure change does not create discontinuity and fear amongst carers and providers.
But some will not and therein lies the third, and thus far most worrying, appearance of change: an emergent tendency to engage in what could generously be described as “action research” but feels more like ‘changing stuff to see what happens’.
Add in to the mix all the usual jockeying, that inevitably accompanies change and competition for funding and position, and it leaves many wondering what the next few months will really bring.
Lost in Transition? bloggers are Chief Executives of independent carers’ organisations, who are providing insights into how NHS reforms are impacting on carers’ services and carers across the country.
Watch this space for more updates about what the changes to the NHS really mean…