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The extent to which the NHS in England will become even more fragmented as a result of the Health and Social Care Act was laid bare by the Department of Health last week. It published a circular graphic that is designed to explain how the various components of the NHS will fit together once the act takes full effect next April.
The graphic shows there are five organisations that will safeguard patients' interests, nine to support care providers and three charged with 'empowering patients and local communities'. Promoting public health will be the responsibility of Public Health England and more than 30 local authorities, while most commissioning will be undertaken by 212 clinical commissioning groups.
As you may have noted, this plethora of quangos and councils will not deliver any health care at all. That will be left to more than 200 acute and mental health trusts, 8,300 general practices and 18,000 care homes, not to mention other providers in the independent and voluntary sectors. Each constituent part has its own management structures, budgets and priorities, so it is inevitable that health services will be riddled by inefficiencies.
The government's approach is likely to make matters worse, not better. This is demonstrated by the crisis afflicting South London Healthcare NHS Trust, which surfaced last week. The trust runs three large hospitals. Despite producing good outcomes, it has a deficit of £69 million and pays out £61 million a year to cover the cost of a private finance initiative project.
In response, the government has appointed an administrator who will produce a report making recommendations on which services should be retained, and which can be axed or provided elsewhere. This must be devastating news for the trust's nurses and healthcare assistants, who face uncertain futures. It has also prompted concerns that services across south London will be hived off to the private and voluntary sectors, making for an even more fragmented health system than already exists. It seems that the government is prepared to prop up banks on the grounds they are too big to fail, but is prepared to let parts of the NHS be broken up into fragments that are too small to succeed. An uncertain future indeed.
Editorial | July 4 | Volume 26 No 44 | 2012
Nursing Standard is published every Wednesday by RCN Publishing Company Ltd, the publishing company of the Royal College of Nursing.
It seeks to promote professional excellence, and encourage creativity and innovation in nursing, midwifery and health visiting practice. Nursing Standard also aims to enhance nurses' and healthcare assistants' career development and to help them achieve and maintain a healthy and rewarding working environment. Nursing Standard is editorially independent and the opinions expressed are not those of the RCN or of the contributor's employing organisation unless specifically stated.