Reforms pull in two directions: Corrigan

Power in the NHS will be both centralised and distributed locally by the the latest round of reforms, health policy consultant Paul Corrigan told EHI Live 2011.

Corrigan told the first session of the conference at the NEC in Birmingham that health secretary Andrew Lansley intended to move power from the centre to local organisations, clinicians and patients when he launched the 'Liberating the NHS' reforms in June 2010.

The health policy expert, who was a government advisor during successive Labour administrations, suggested the health secretary had been surprised by the reaction of the NHS and public.

They made it clear that they expected ministers to remain accountable for the health service, and for it to deliver more or less consistent services across the country, he said.

The listening exercise that Lansley was forced to conduct through the NHS Future Forum, and the changes to the Health and Social Care Bill that had been introduced by the Lords, had reintroduced a large degree of centralisation.

The changes had resulted in a stronger role for Monitor as a regulator of the new health system; for the NHS Commissioning Board in organising a system for commissioning; and for the health secretary, who will continue to take overall accountability for providing a national service.

Yet inexorable trends in patient choice and knowledge, coupled with the need to provide integrated care for the 15m people with long term conditions, were driving a demand for more personalised services, Corrigan argued.

As a result, new, integrated care organisations would be needed that might draw on private sector resources, and these would need IT, as would patients.

He said: “Seventy per cent of the NHS expenditure goes on long term conditions and people need coherent patient pathways. If we do not provide these then the health service will go bust.”

Corrigan told his audience of NHS managers, IT specialists and vendors, that many people struggled with the contradictory nature of the reforms, demanding that the NHS “make up its mind” about whether it should centralise or decentralise.

But he argued that neither the NHS nor the public had any need to make up their minds and that both could co-exist.

The result could be likened to Tesco, in which every shopper makes their individual choices from the same shelves of food, but the company shapes those choices through its centralised purchasing and distribution.  

“My basket is unique,” he said. “Tesco’s expertise is in sourcing tuna from the Maldives, which is something that I, as an individual, could not hope to do.”

Corrigan went on to argue that this would have profound implications for IT in the NHS. Some IT would still be needed centrally, but other IT would emerge from the demands of local organisations and individuals.

He argued that the best outcome would be for local innovation to be recognised and diffused by "some kind of" central IT organisation, leading to horizontal rather than vertical integration of systems.

Members of the audience suggested that this would only be achieved through the NHS adopting standards for IT systems that would allow them to interoperate.