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Milburn unveils NHS overhaul
By: Patrick Butler
The Guardian, April 25, 2001
The health secretary, Alan Milburn, today signalled his intention to up the pace of the government's NHS reforms, unveiling a massive restructuring plan aimed at devolving more power and resources from Whitehall to frontline staff.
Mr Milburn promised that Labour's approach to the NHS in a second term of government would be to give doctors, nurses and other care staff more influence to shape local services by giving them more control over budgets and care purchasing decisions.
"Too much of the NHS today still feels like a centrally run bureaucracy to those at the frontline. This has to change. The time has now come to free the NHS frontline," he told an audience of health service managers in London.
He promised to strip out layers of "top heavy" NHS administration by axing around 60 of the current 99 health authorities
(HAs) in England, radically reforming the Department of Health (DoH), and strengthening NHS links with regional and local government.
Hundreds of NHS and civil service administrative jobs will disappear as a result of a
"rationalisation" of the middle tier of health service management to be phased in by 2004, releasing £100m for patient care.
Mr Milburn said: "Organisational change of course carries the risk of bringing instability and so could impede reform, I recognise that. But I have been convinced by people in the NHS that change is now needed to take reform forward and embed a new decentralised approach.
"Not a big bang tomorrow but a phased programme to put power and resources in the hands of the NHS frontline."
The reform programme includes:
• The merger of existing health authorities into around 30 "strategic" authorities, covering populations of 1.5m. They will hold hospital trusts and primary care trusts
(PCTs) to account, and resolve local disputes.
• Reform of managerial appointments - management of the strategic authorities may be offered to tender on a "franchise" basis, with "the best performing management teams" invited to apply.
• The appointment of possibly nine regional DoH directors of health and social care, each with a "small core group of staff," to "oversee" the health service and develop links with regional government.
• The abolition of the eight DoH regional offices, each of which employ around 150 civil servants, along with the abolition of the NHS executive, the operational management arm of the
DoH.
• Reform of the DOH to become a "model for the modern service-delivery" Whitehall department. This will include the appointment of more NHS 'tsars' and other staff to civil service positions.
The programme will go some way to meeting mounting criticism from doctors and managers about the punishing pace of Labour's reforms, and the perceived centralisation of decision making and performance management in Whitehall.
But while Mr Milburn admitted "the NHS cannot be run from Whitehall" he insisted that Labour had been right to exercise strong central control in its first term to establish "a clear national framework within which local services can operate".
With that framework in place, Labour intends to "shift the centre of gravity to the NHS frontline…Just as schools have greater control over resources and how they are
organised, so local health services must now be given greater control."
He recognised that many staff were weary from nearly two decades of NHS reforms. But he insisted there would be no let up on the pace of change: "My message is simple; reform must happen."
British Medical Association chiarman Dr Ian Bogle gave a catious welcome to the plans: "The intention of today's announcement, to cut bureaucracy and decentralise the
NHS, is something we support.
"Anything that helps doctors treat their patients better is to be welcomed. But similar promises have been made in the past and have been constrained by central guidance and control."
Shadow health secretary Liam Fox said: "This has all the hallmarks of a panic reaction with the secretary of state desperately trying to head off a crisis in the medical profession that his own centralising tendencies has produced.
"With consultants and GPs threatening to leave the NHS, the secretary of state has clearly seen how popular Conservative plans are proving to be." |
