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Leaders 'unclear on who's driving' NHS culture change

Leaders 'unclear on who's driving' NHS culture change

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Healthcare leaders claim that the structure of the NHS is “confusing” post-Health and Social Care Act. 

Jeremy Hunt, Health Secretary, called for a “culture change” in the NHS during a speech at a fringe meeting during the Conservative Party conference in Birmingham. 

But the heads of the Royal College of Nursing (RCN) and Nuffield Trust said that although they agree culture change is needed, it’s unclear who should be responsible for leading it. 

Hunt said it is time to move “away from targets and towards transparency”. Instead, peer-review should be used as a way to monitor performance. 

The integration of health and social care is also vital, Hunt says, as is a move towards personal care in health as well as social care. 

When grilled on who should be responsible for overseeing culture change, Hunt said: “First of all, clinical commissioning groups (CCGs) are responsible for making sure that [patients] get fantastic care across the health and social care system. They are the ones who are commissioning services. 

“We don’t just want CCGs to be commissioning hospital care, we want them to be responsible for commissioning out of hospital care as well and involved in the commissioning of social care, together with the local council.”

He added: “[But] I think the legislation is clear, the Secretary of State for Health is accountable for the NHS and will remain accountable.” 

Dr Peter Carter, Royal College of Nursing (RCN) chief executive issued a plea to the Conservatives not to reorganise the NHS if they get into power following the election as “people do not understand” the current system and need clarity. 

And Nigel Edwards, chief executive of health think tank the Nuffield Trust said that even with a diagram of the NHS “it’s not very clear who’s in charge”. 

Edwards said: “Culture change is quite a difficult concept to get one’s head around. Maybe increased transparency will help - maybe more time is needed to learn some of these new ways of working. 

“I don’t think we fully know the answer, but it’s certainly hard to do in a system where it’s unclear who’s driving which parts of it.” 

Although Dr Carter noted that patients and people working in the NHS find the current structure had to understand, he said it would be a “waste of time, money and effort” to reorganise again. 

“The current structures are confusing and people don’t understand them. My advice to [Jeremy Hunt] is to work with the existing structures, despite their limitations, and get some more clarity so that people will know that when you pull certain levers who’s responsible - because right now that isn’t clear.” 

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