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The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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Why does the new architecture of the NHS have to pretend so hard to be something else?

Filed Under (Foundation Trusts, National Commissioning Board, NTDA) by Paul on 18-07-2012

Monday saw the NHS Trust Development Authority  (NTDA) appoint its second tier of staff. Leaving aside the fact that it looks now as if the NHS is a completely closed shop – with no external advertising for what are all very important posts being filled over this month or so – there are some very good people being appointed.

As the new architecture emerges from the mist it is clear that the NTDA is really very important.

Given that nearly all of the old SHAs had Chief Executives who cut their NHS teeth running hospitals, it was inevitable that the main part of the NHS in which SHAs were really interested was the organisation of NHS provision. For many SHA leaderships the role of PCT commissioning was to efficiently hand the money over to where the real action was – in the hospitals. Once this was done PCTs no longer attracted the gaze of the SHAs.

But many of those people – who used run SHAs and will still be in NHS employment after next April – will find themselves working in the NCB, and sooner rather than later the senior staff of that organisation will look at their letterhead and realise that it is a commissioning and not a provider organisation.

This will take a while, but it will be massively assisted by the fact that the non-executive NCB contingent have not spent their careers running NHS hospitals – and all of them look to me as if they understand that the job of their organisation is to commission care and not to provide it.

From next April the NTDA will be the organisation receiving all of the power over NHS provision that at the moment sits with the SHAs. From 1/04/2013 all of those NHS trusts that have not made it to Foundation Trust status will find themselves being performance managed by it.

In January 2012 in the forward to the document Building the NHS Trust Development Authority, David Nicholson wrote “The NTDA will work with some of the most challenged NHS providers in the country, supporting them on their journey to NHS foundation trust status” 

This is where the new architecture descends into myth. To believe that these trusts will become FTs by moving down the pipeline and being granted FT status as trusts by Monitor is a fairy tale.

The NDTA will, so the myth goes, take over the pipeline that is at the moment run by the SHAs and they will be ushering those few trusts that have not made it to FT status over the finishing line. Most of these, the myth continues, will reach FT status within the year – by April 2014 – and the few stragglers will need to be rounded up to get over the line within the final year of the Parliament.

So goes the folk tale.

In reality the vast majority of the trusts that come into the aegis of the NHS Trust Development Authority will not become Foundation Trusts. Many of their current plans to meet a date in the pipeline are based upon very strange economic projections which bear little relationship to the looming economic reality for the NHS.

All of them have developed these plans under pressure from the SHAs to fix a date in the pipeline. The projections have then been developed in order to meet that date, rather than the other way round. In this odd world one Trust CEO in the pipeline has been quoted in the HSJ as saying that their work on becoming an FT was all on track “except for the finances”. It’s rather difficult to know what the whole application process of applying for FT status means – “except for the finances”.

So the reality is that NTDA will be developing NHS trusts – most of which will not succeed in gaining FT status. Its main activity will be looking to existing FTs to themselves take over these NHS Trusts – thereby making them into FT providers.

The (literally) billion dollar question for the future of NHS provision is why on earth should FTs take the very large risk of doing that?          

When the NTDA can answer that question they will be able to carry out their task.


2 Responses to “Why does the new architecture of the NHS have to pretend so hard to be something else?”

  1. look at Peterborough & Stamford for the answer

  2. I attended the NHS Commissioning Board meeting yesterday to hear this debate.It seems Sir Neil McKay is leading on all the HR issues,if you take time to look at the live recording his name was mentioned about 8 or 9 times in relation to the changes being made.I do wonder what his future role
    considering he turned down working for the NHS commissioning Board?We in LEEDS have about 600000 reasons to be worried about these new arrangements.Ian Dalton did give a really good account of the progress his team have made to date as did Ms Hakin which is reassuring for the public.

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