Devolution and Reform of Health and Social Care

You can find a summary of our report here.

The coronavirus crisis has highlighted two things: the UK’s frontline NHS and care staff are skilled and selfless; the system in which they work had serious flaws going into the pandemic and will be even more exposed coming out of the crisis. We owe it to frontline workers to implement measured reforms that smooth the patient journey and enhance the quality of the clinician-patient bond. This report warns against the failed top-down reorganisations of the past, and outlines productive change that has been tested and proven in real clinical practice.

Key Recommendations:

Structural reform of the NHS is long overdue.

The integration of health and social care will not only be more efficient for hospitals, but it will also be beneficial to the most vulnerable populations. Pooled funding, reformed management structure and devolved authority, and a CQC that promotes learning and growth among clinicians to improve patient safety are essential.

There are operational measures that can improve patient outcomes in the short term. Consolidating GP practices into polyclinics would create less stressful work environments for clinicians, while shifting focus from reactive and acute work to coordinating care for vulnerable patients. Restructuring of A&E and Emergency Pathways will improve efficiency; clinicians must be supported in regaining and maintaining control of their clinical environment to reduce stress, low morale, and burnout.

Refocusing a clear vision on high-quality care is crucial. From this vantage point, devolved health authorities, patients, and local communities can take a bottom-up approach in designing clinical care processes and linking organisations and care systems. This bottom-up approach should be utilised in reforms in regulation, education, and legal and financial systems that affect the local healthcare environment.

Report Authors:

Ian Smith, Stephen K. Smith & Phillip Blond