Post Brexit… Why will NHSI/E want to tell everyone what to do?

Whenever the Government gets around to launching the NHS Long-term Plan, the NHS will have the opportunity, given by whoever is then Prime Minister, to put forward some ideas for new legislation. One can imagine all sorts of priorities that would be helpful, but apparently what NHSE/I really want is to have the opportunity to tell all hospitals, including Foundation Trusts (FTs), what to do.

There are apparently a number of reasons for this. The one that we are being told is most important is integration. Apparently giving NHSE/I control over providers will mean it being able to tell them to integrate with their neighbours and then, obviously, having been told to integrate – well… they will.

But the others – the FTs – can’t be told, they have to be asked. And because they have to be asked rather than told – well they don’t just do it.

The other much more likely reason, one that lies at the heart of NHSE/I performance management, is control of the money. NHSE/I can tell non-FTs what to do with their money. But they can’t tell FTs what to do with their money, they can only ask them about it.

The request for legislation to abolish FT status is a request that says we can’t really achieve anything if we have to ask people to do things – we have to tell them. And that we need a new bit of law to give us the right to tell more providers what to do. Without that there can be no integration and no control of the money.

The great thing about this is that at the moment we have a very big living breathing experiment going on about whether telling people to do something is more efficacious than asking them.

At the moment we have a bunch of providers (non-FTs) that NHSE/I has the right to tell what to do. Given its national policy, NHSE/I tell non-FTs to integrate and they tell them to look after the money.

So how’s that going?

Then there is another bunch of providers that they can’t tell – but have to ask – the FTs. (It must be said that a lot of this ‘asking’ seems very like ‘telling’ – but in law its asking). Boards of FTs decide how they want to integrate and how to deal with the money.

So how’s that going?

So we have a national experiment at the moment and can examine, in terms of integration and financial control, the outcomes of organisations that are being told by NHSE/I what to do (non FTs), and compare them with organisations that NHSE/I do not have control over (but want it).

I’m sure NHSE/I will have carried out research on whether integration is further forward amongst those providers who they can tell what to do as against those providers who they can’t.

I am equally sure that they have carried out research on the money. Is there better control of the money in those institutions that NHSE/I control than those they don’t?

And when the proposal for legislation is made, I am sure some MPs will ask for the results of this research as a part of the reasoning for the legislation.

If that were to show that organisations that are not controlled by NHSE/I (the FTs) are more inclined to integrate and are better with their money, it would look very odd for NHSE/I to be arguing for more control of them. (Especially as that control is not working with existing non-FTs).

It might give the somewhat odd impression that they wanted to control everyone just for the sake of controlling everyone.