View June's Board Pack - Royal Bournemouth Hospital

Where next for the NHS reforms in England?In this way, choice and competition would go hand inhand with collaboration.Moving in this direction beyond the current reformswould be a radical step. Many of our proposals have beenset out at a high level and more work is needed on thedetail. It is for these reasons that we have emphasisedthe need for an evolutionary approach that startsfrom the reforms currently proposed, modifies thesereforms in the way we have suggested, and creates abasis for further changes in the light of experience. Thiskind of approach would help to avoid further top-downrestructurings and would encourage experimentationfrom within the NHS led by innovative clinicians andmanagers. In our view, there would be merit in testingthe radical option in one or two regions to explore therisks and benefits of such an approach.Summary and conclusionThe proposals set out in this paper are offered as aconstructive contribution to the listening exercisewith the aim of building on recent progress inimproving the performance of the NHS in England andcreating the foundations on which the NHS can riseto future challenges. The proposals are intended tobe a co-ordinated package of ideas for improving thegovernment’s current plans that need to be acted ontogether. If the government’s response to this paper is totake forward some proposals and ignore others, then it isunlikely that the plans will be strong enough to addressthe concerns we have expressed in recent months. Itis also important to emphasise the need to evolve inthe direction we have proposed rather than to embarkon a rapid process of change, and in doing so to retainexperienced leaders whose involvement is essential todelivery of the Nicholson challenge.We would argue that the proposals are both appropriateand proportionate to the issues that need to beaddressed and that, if executed well, they shouldenable the NHS to meet the Nicholson challenge andabove all to improve outcomes for patients. Some of ourproposals, such as those on economic regulation, requiremodifications to the Bill, but most can and should bedealt with through established policy-making processes.The agenda set out here must be taken forward as amatter of urgency to remove barriers to the delivery ofintegrated care and to tackle the core challenge of anageing population in which chronic medical conditionsrepresent a threat to the sustainability of a universal,comprehensive, tax-funded health care system.18 © The King’s Fund 2011