NHS papers expose risks of health reforms
The government's health reforms run a high risk of reducing levels of safety and patient care while leading to overspending, internal NHS reports have warned.
The potential for conflict between NHS organisations in the new system and upheaval during the transition is high, according to risk assessments drawn up by the four English NHS regions. There is also a high chance the reforms will fail to achieve hoped-for management improvements and budget cuts, they say.
Some of the anticipated problems are rated at the highest risk category, "significant", and many others are considered "high risk", even after mitigation measures designed to tackle the issues raised, and despite all actions taken after previous risk reports last autumn.
The warnings – dated January and not due to be updated for three months – will be in place when the controversial health and social care bill becomes law, provided the government succeeds in getting it passed before Easter.
According to the report for the north of England, risks rated 15 or higher are considered "significant" and coded in red; those from 8 to 12 are judged "high" or amber risk. In the north of England officials warn the risk of achieving "productivity gains at the expense of quality", defined as "safety, clinical effectiveness and patient experience", rates as 12 – a possible event with major impact – even after the mitigation actions so far chosen are taken.
The same report warns of a similarly high risk of "organisational and system instability" damaging management and governance, and uncertainty caused by the changes that could reduce the capacity and capability of staff and organisations.
Lower rated problems – still considered high risks – cover a wide range, again after existing mitigation, including a "loss of grip on current performance", that "safety is compromised by lack of clarity on accountability, poor morale, and loss of knowledge", that the benefits of the reforms are not achieved, and there is a loss of public confidence in the NHS.
In the Midlands and east of England, officials are most concerned that a combination of targets to reduce spending, and the management changes, will cause upheaval during the transition, and similarly warn of worse quality and safety, conflict between organisations, neglect of primary care, overspending, and failure to meet key targets such as limiting the number of patients who wait more than 18 weeks for treatment.
Moderate risks in the region include loss of key personnel, staff working in "silos" and so not co-operating as they need to, a rising risk of fraud, lack of clarity about structures for commissioning treatment for patients, staff distracted or overloaded by the upheaval leading to worse service and higher sickness levels among health service staff themselves, confused and unclear accountability leading to "organisational and system failures", culture clashes, "mission critical" staff leaving, lack of leadership skills among key staff, and loss of confidence among clinical staff leading to the reforms failing.