One of the aims of the health white paper and the more recent health bill has been to allow health decisions to be made at a more local level. This should allow commissioning decisions to be made with the local population in mind, and should keep those involved in commissioning and providing care accountable at a local level.
Many functions, however, do not need to be undertaken at a local level, and instead would benefit from being carried out at scale. These functions do not directly depend upon the patient population and will not affect outcomes so long as they are efficiently carried out. Examples include such things as back office functions, procurement, and IT infrastructure.
Such functions need to be facilitated at a national level, either by the commissioning board or the Department of Health. Another option would be for many consortia to commission services from national bodies that already exist. I was pleased to see that NHS Direct has already begun to hold talks with several consortia to look at how it can support consortia in their triage and appointment bookings, another function which does not need to be done locally.
I hope that, as the new structures continue to develop, we will see examples of where consortia themselves have worked together in order to do things at scale. The changes of the health bill, whilst devolving power to a local level, do not have to mean a fragmented NHS.