Can the new NHS bodies solve the current problems?

Can the new NHS bodies solve the current problems? Few people would look at the new NHS structure and conclude that the health service needs more organisations.

Who is in charge? Hidden among the predictable dissection of urgent and emergency care woes in the health select committee report, published on Wednesday, are serious concerns about whether the myriad of new NHS bodies are capable of sorting the problems out.

Few people would look at the new NHS structure – which bears more than a passing resemblance to the piping diagram for a gas works – and conclude that what the NHS needs is yet more organisations. But that was indeed what NHS England decided when faced with growing problems in A&E.

Ignoring the primacy of clinical commissioning groups, it imposed urgent care boards across the country, under the auspices of its local area teams, charged with rapidly producing plans to sort out A&E. But it then seemed to lose its nerve. The health select committee says it is "unclear whether [the boards] are voluntary or compulsory, temporary or permanent, established structures or informal meeting groups". They seem to have power, but questionable formal authority, weak accountability and no money.

This is more than a matter of organisational tidiness. The committee points out that the local A&E plans will need to be funded with cash which CCGs have already allocated – so the boards are spending someone else's money, hardly a robust set-up for ensuring it is used to best effect.

In some areas this could trigger a tussle for control, particularly if emergency care boards follow the logic identified by the committee that they will need to make recommendations for disinvestment elsewhere to fund their plans. Why should these boards be not just taking over A&E but trampling over the rest of a CCG's priorities in the process?

It is extraordinary that NHS England has managed to introduce further complexity and muddle into a new and unstable structure that is already awash with uncertainty and risk. As the committee highlights, urgent care boards blur lines of accountability and responsibility and create yet more complications around budget holding and commissioning.

In measured parliamentary tones, the committee has told NHS England to sort this mess out. At a time when even the best CCGs still have a long way to go to establish themselves, and many health and wellbeing boards are having an uncertain start, they do not need to be destabilised by the imposition of another commissioning organisation. NHS England should be helping them succeed, not undermining them at the first sign of difficulty.

The two existing bodies need to own the problems and work with the range of local health partners to deliver and fund the solutions. An outpost of NHS England's local area team is not the answer.

The health select committee notes that the urgent care boards were frequently described to them as meeting a need to introduce "system management into the system", and suggests that if they are indeed needed to fulfil that role they should be compulsory and permanent.

It is easy to see the temptation for NHS England to go down this road. It pushes aside the need to support CCGs and health and wellbeing boards in developing their own skills to manage this difficult issue and replaces it with the default NHS option of centralised control.

CCGs should resist such a move. It would rapidly lead to them ceding oversight of major local services and effectively handing over a chunk of their budget to a new, major commissioning body.

Sorting out A&E is evolving into a test case of the new structures. There are few if any parts of a local health system which do not in some way help or hinder the provision of timely, high quality urgent and emergency care. If CCGs become marginalised in this, they are substantially diminished.

How all this develops will determine whether CCGs and health and well-being boards are to be given the space, time and support to fulfil their roles, or whether the idea of local solutions and accountability begins to wither in the face of a renewed wave of centralisation. Guardian Professional.