Conclusion

Effective governance structures and a clear operating model are needed if the health and care system is to deliver recovery, reorganisation and reform.

The government has provided a clear vision for the health and care system through its three shifts (the ‘what’). A new system operating model is needed to provide clarity on the functions (the ‘how’) that are needed to shift towards a more preventative and empowering model of care and roles and responsibilities for delivery (the ‘who’). The model must leave sufficient room for local discretion in determining which organisations lead the shift towards a more preventative and empowering model of care, building on what is already working and avoiding delay and distraction from undoing existing effective models. Rather than privileging one model, the centre should create strong incentives for systems and providers to develop a credible collaboration and accountability model that suits their local legacy and assets.

This transformation should be guided by the principles of devolution and subsidiarity, a system approach to change, and clarity and accountability. The ten-year health plan must align policies to incentivise these shifts, ensuring a more effective, efficient and citizen-centred healthcare system.

The NHS Confederation will be doing some more detailed work on delivery models for the left shift and neighbourhood health. Please get in touch with Annie Bliss to find out more.