Headlines: July 28th, 2000

The NHS Plan announced by Prime Minister Tony Blair sets out a blueprint for changing the culture of the health service over a number of years. Possibly the most important culture change lever is the shift in the balance of power. There will be empowerment for patients which will go well beyond making it simpler and easier to complain. It is claimed that the Plan is designed round patients and giving them a voice will ensure that the services progressively become more patient centred and more responsive to the changing needs. Experience elsewhere in the public sector shows that customer oriented services take a long time to develop with many factors hampering progress.Power will also move from the centre to professionals on the ground, but only to those who perform well. This is described as ‘earned autonomy’. This power shift will be based on establishing a National Service Framework of standards to which all Trusts will have to conform. The aim is to give people on the ground the freedom to innovate and find new solutions to local problems whilst maintaining or improving quality.

The Plan also sweeps away lines of demarcation and introduces a flexible approach both within the service and between the health service and social services. The role of nurses will be extended to prescribing medicines and other tasks. GPs will undertake wider functions including minor surgery and diagnostic tests. The current divide between the NHS and social services which results in older people blocking hospital beds, when they have no further medical need, will be bridged by pooling budgets. This will provide funding for support to patients in the home and allow them to be discharged from hospital more quickly.

The Plan represents the greatest and most ambitious change management task ever attempted in public service in the UK and probably in the world. There is no other change programme to give insights into how implementation might progress or founder. For this reason there is a proposal to set up a Modernisation Agency to share ideas and spread good practice. It will probably follow the model of the local government Improvement and Development Agenc