NHS Providers welcomed the interim report which set out a helpful picture of the current position in the NHS and the social care sector, and highlighted areas which need to be addressed. We agree with the interim report's assessment of the implications of austerity on the health care system.

Key points include:

• Given the prospect of a longer term funding settlement, the impetus behind STPs and ICSs (despite lack of legislative change), the forthcoming social care green paper and a rising recognition that change is needed to avoid a crisis in patient safety and quality of care, this review is timely and we welcomed the findings in the interim report.

• While improvements have been made since the original High quality of care for all report was published; patient satisfaction with the NHS remains high; and some trusts, despite the unprecedented pressures, are improving, the interim report rightly highlights that patient safety remains a concern. We encourage the review team to consider the current risk of the finance/quality pendulum swinging too far and the impact this could have on safety.

• There is common agreement that more collaborative approaches will serve populations better and make better use of collective resources but there is a lack of clarity about how this vision, via STPs and ICSs should translate on the ground. Without removing ownership from local places, politicians and the national bodies need to send align incentives behind a more collaborative and less competitive approach, and indicate how functions such as commissioning should operate within the new landscape. It would be helpful for the review team to consider this.

• As change is being led within the existing legislative framework, there has been little requirement for statutory consultation. However we are keen to see a fuller process of engagement from the national bodies. In addition there is a lack of coherent narrative for the public about the purpose and ‘end state’ for new initiatives.

• Overall the difficulty of the task facing health and social care should not be underestimated - wide-ranging transformation is being undertaken against a backdrop of an increasingly unstable service and a widening financial gap, with complex new local system relationships being developed at a point when leadership and management capacity is already under pressure.

• We look forward to the final report and encourage the review team to be specific in its
recommendations and set out a clear vision for how we achieve high quality care for all in the
current context.