up the NHS. The changes are being carried out during the tightest financial squeezeon health services finances since the 1950s.7.
Furthermore, NHS reorganisation was explicitly ruled out in the Conservativeelection manifesto and the Coalition Agreement in May 2010. So the huge upheavallaunched by the White Paper just two months later was unexpected; and the NHSand civil service were unprepared.8.
Risk has therefore been at the heart of concern about the NHS reforms from theoutset. Lack of evidence and confidence about how well the Government wasprepared to manage the risks was a major cause of growing professional, public andParliamentary alarm at the plans in Autumn 2010 and Winter 2011.9.
The Conservative-chaired, All-Party Health Select Committee published its 2
Reportof the 2010-11 session
on ‘Public Expenditure’ in December 2010. It observed:
“We have heard numerous warnings of the risks involved in combining the tight spending
envelope and the need for unprecedented efficiency savings with the large-scalereorganisation of NHS structures
There are clear risks associated with the transition period. For example, SHAs and PCTs willcease to exist, but there will be a reliance on them in the short-term around both managingthe transition period and delivering ongoing efficiency savings, such as those associated withthe QIPP programme ...Even if well managed, widespread organisation reform can meanservices stand still for a period rather than progress. If managed poorly, services andfinances may suffer. There is clear evidence that organisations distracted by reform can
experience major financial and service failure.”
In its 3
Report on ‘Commissioning’ published in January 2011
the Select Committeeconcluded:
"Like most observers, the Committee was surprised by the change of approach between theCoalition Programme and the White Paper. The White Paper proposes a disruptivereorganisation of the institutional structure of the NHS which was subject to little priordiscussion and not foreshadowed in the Coalition Programme.
While such a “surprise”
approach is not necessarily wrong, it does increase the level of risk involved in policyimplementation. It allows less time to understand complexity and detail, and less time todevelop and explain policy; and it leads to less understanding of objectives by staff, patients
and local communities. A successful “surprise” strategy requires clarity and planning, but the
Committee does not think that the White Paper reflected these qualities. There appears to