Redrawing the health and social care architecture

03 November 2016

The NHS is rightly a source of national pride in the UK. But the service today is under significant financial and demand pressures. These pressures only look set to increase and the demands on the service and on social care services provided by local councils mean we need a radical shift in the way health and care services are delivered.

This challenge has been embraced by local providers and commissioners up and down the country in line with the vision presented by the Five Year Forward View. However, to date there has been a missing piece to the jigsaw: what is the role of national structures in enabling the delivery of localised and integrated care, and how can this role be optimised?

This is the question we’ve been exploring over the past six months.  We’ve held extensive dialogue with senior leaders at national, regional and local levels across the service to canvass their views. We’ve consulted over 1,000 people working across the health service, from the Department of Health, NHS England and NHS Improvement through to the front line. And we’ve conducted a polling exercise involving over 2,000 members of the public.

What we found is a widespread feeling that the current national structure is ill-designed for the vision which the service has set itself.  Our research highlights a persistent underlying sense of confusion about the roles of national bodies in the NHS, coupled with frustration over the division between health and social care.  What we also found is a growing appetite for reform.

With this in mind, today we’ve published our final report, Redrawing the health and social care architecture.   The report sets out a bold and radical way in which policy makers could seek to move forward.  Our recommendations, covering short term simplification and longer term reform include:

Short term:

  • Create a new Care Management Board or merging NHS Improvement and NHS England - to simplify the structure of the current health and care system
  • Clarify and coordinate the work of local institutions
  • Delegate responsibility for managing the health and care system in their areas to Sustainability and Transformation Planning (STPs)
  • Clarify the role of The Department for Health and The Department of Communities and Local Government in healthcare.

Longer term:

  • Shift accountability to the local level by allowing Regional Care Groups to evolve into democratically accountable bodies and have responsibility for commissioning health and social care.
  • Give local democratically accountable leaders powers to raise additional funds through taxation.
  • Shift control of healthcare to local areas

Clearly a structural change can only be an enabler to a much broader set of changes and innovations that the sector needs – but moving on from today’s imperfect approach is necessary.  In the midst of the pressures health and social care is facing, it is essential that this debate does not fall to the bottom of the pile.

Download the full report at

David Morris | Partner
Email | +44 (0)7841 784 180

View David's profile on LinkedIn




Verify your Comment

Previewing your Comment

This is only a preview. Your comment has not yet been posted.

Your comment could not be posted. Error type:
Your comment has been saved. Comments are moderated and will not appear until approved by the author. Post another comment

The letters and numbers you entered did not match the image. Please try again.

As a final step before posting your comment, enter the letters and numbers you see in the image below. This prevents automated programs from posting comments.

Having trouble reading this image? View an alternate.


Post a comment

Comments are moderated and will not appear until the author has approved them.