Professionals doubt devolution plans

Health and social care organisations have
questioned whether government plans to devolve power to the front
line will actually happen, according to a Department of Health
paper last week on the implementation process for its Shifting
the Balance initiative.

The paper also lists concerns that the time
and effort to put in place the necessary structural changes – such
as the development of 30 new strategic health authorities, the
abolition of NHS regional offices and the creation of four new
regional directors of health and social care – will take the focus
away from delivery of the NHS Plan.

Also, the paper states there is a need for
clarity between some of the proposed roles of the strategic health
authorities and the regional directors, as well as uncertainty over
the potential contribution of local authorities in the new
structure, where primary care trusts will be the “cornerstone” of
the NHS, controlling about 75 per cent of the NHS budget.

The concerns come from more than 400
organisations in response to a consultation launched last July on
the structural and management change entailed in delivering the NHS
Plan.

Last week’s report responds to the reactions
from primary care trusts, health authorities and NHS trusts, as
well as councils, voluntary organisations and local representative
committees.

“Shifting the Balance of Power is
radical in concept. But it also needs to be radical in reality,”
says NHS chief executive and DoH permanent secretary Nigel Crisp in
the paper. “Behaviour needs to change as well as organisation. And
the new structures themselves need to be very different from the
old with greater focus on team working and on enabling and
supporting people, and less on hierarchy and control.”