Policymakers have been told that they must do more to show they understand the pressures facing NHS staff as they work to implement the government’s healthcare reforms.

They also need to do more to mitigate risks and convince NHS employees that the Service is on the right course, according to Nigel Edwards, acting chief executive of the NHS Confederation.

As the NHS faces what could be the toughest year in its 62-year history, it will need all the help it can get, Mr Edwards has warned. He emphasised that the Confederation supports the objectives of the government’s healthcare reforms, and fully appreciates that the need for efficiency savings is “inescapable” against a backdrop of rising costs and a spending settlement which, although flat in real terms,  is “as good as the NHS could have hoped for under the economic circumstances.”

However, there are a number of key concerns which, if not fully recognised, will be “dealt with poorly, and patients will be the losers,” he cautions.

These issues include: - the disruption and potential loss of momentum caused by the biggest-ever shake-up of NHS structures; - the difficulty of managing an ambitious £15-£20 billion efficiency drive that will have negative effects on both patients and staff; - the ability to cope with all these changes, caused by the largest-ever cuts in management capacity; and - the uncertainty created by the debate over a major piece of healthcare legislation, with decisions needed on who is accountable for what and where power lies.

“The government and Parliament must tell a compelling story about why the reforms will deliver a significant improvement for patients and how the reforms will actually work in practice,” said Mr Edwards. As the state withdraws from the day-to-day management of healthcare and power, accountability and decision making will work in new ways, and the culture change for NHS staff, politicians, the media and the public is even larger than the technical and structural changes being introduced, he added.

Accountability will be central to making the new system work and will need to be crystal clear; however, it remains a grey area and is therefore one of the biggest risks to the reforms working, he warned.  

Parliament will also have to grapple with the issue of whether the reforms are powerful enough to achieve their goals, Mr Edwards went on. “For instance, it’s easy to support giving patients more choice and comparative information on services, but will that actually drive significant improvement in the quality of care?”

But it is the transition that is causing greatest anxiety to the NHS, and the necessity of avoiding hazards such as financial problems and failings in patient care during the period, he stressed. 

In 1948 the NHS was a centrally planned and managed organization, today it is more a loosely connected system of organizations and under the proposed reforms “it will become like a regulated industry similar to the utilities. That could trigger major reshaping of the way care is delivered, with services closing and changing,” he said.

“To deal with the financial issues, long-standing trends in medicine and workforce pressures, there will also need to be some bold decisions about the future of some services and institutions,” Mr Edwards warned.