Through the work of Donaldson and the Department’s Review of Commissioning, we know there is a perception that the current administrative structures carry too much complexity and have too many layers of authority. Those working within the system feel that the number of stages in decision making, often involving several bodies, can slow things up and may make the whole system less responsive. This has caused some frustrations among staff and managers across the system, many of whom feel the emphasis has been placed more on transactions rather than enabling transformation.
This complexity may also have contributed to a situation where lines of accountability are perhaps weaker than they should be, with a lack of clarity about where responsibility for decisions sits. Moving forward, it has been argued that we need to shift the balance between management and leadership.
It is therefore proposed to de-layer the health and social care system by moving away from the current commissioning model and closing down the Health and Social Care Board. This will allow the Department to take firmer strategic control of the health and social care system. It will also allow Trusts to take control of planning the delivery of local services more effectively. The PHA will be retained in order to ensure a renewed focus on early intervention and prevention.