The long awaited Health and Social Care Act finally received Royal Assent last month. The drivers behind the Act, the “Listening Exercise” and the tortuous passage of the Bill through the Houses are well documented – and do not need to be rehearsed here. However, the actual impact of the Act will be significant – even if the true implications are yet to be fully understood. With any seismic change of this nature, there will always be those who cry foul or state a case of the “Emperor’s new clothes”, as has been seen in commentary since the Bill was proposed. A leaner, more efficient NHS that will put patients at its heart of is the goal - but how that will work in practice is now being fleshed out.
What is of real concern for many however, is the lack of transparency regarding the NHS Risk Register. There are in fact two Risk Registers – one dealing with the implementation and operational type risks, and the other being a strategic risk register that was used in the decision making process by ministers. The Department of Health is concerned that disclosure of the second strategic register would expose the worst case planning scenarios, which in turn could lead to critics presenting a distorted view of the likely outcomes – something that the Secretary of State and the Government could well do without. Irrespective of the various legal positions now being considered, the risks articulated may or may not unfold, but the outstanding questions are legion and will have to be addressed in the coming months.
In the interim
The scale and timelines of the change, together with the bandwidth of the current management to deliver on the plans, are the live issues that will focus the best of minds currently. It will require a collective effort led by the NHS - with the close involvement of the private sector including the management consultancies. But there is also a role to be played by highly experienced senior interim managers. This group of experts are driven by delivery that the NHS needs and they have a clear understanding of the organisational environment; the scale of change required is too big to be delivered by in-house resources alone, so an interim management solution may just be the remedy needed.