HSJ has raised the spectre that the Conservatives are planning the end the purchaser/provider split after some 30 years of existence. Albeit the manifesto doesn't say this explicitly. The key questions are:
Will this improve healthcare and control the budget and what impact will this have on social care? This all feels incredibly complex with or without a top down reorganisation. The downsides of NHS reorganisations have a well documented history. Trying to manage a system of separate legal entities with their own Boards and legal duties is a more recent phenomenon with less perspective on the risks and rewards. The role of social care seems largely absent from the reorganisation debate- treated as a spate topic or an afterthought. We have made progress on integrated care to some extent. Clearly we are a long way from integrated public service decision making - which ultimately will drive service change and improvement.
In an ominous echo of 2010, the Conservative party’s 2017 election manifesto includes a discreet mention which could snowball into a disruptive reorganisation of the NHS. While the Lansley reforms simply strengthened the internal market, the intention this time – remarkably – is to curb or abolish it, potentially bringing to an end a 25-year-old era in the NHS. Despite the upheaval this implies, the idea of change will be tempting for many in the health service. The current setup is causing serious problems and, with NHS England preparing to announce the first set of “accountable care systems” The relevant lines in the Tory manifesto have been presented as an open offer to the NHS to help with its predicament. As in 2010, the starting point is not an explicit desire for a massive restructure.