The Health & Social Care Act 2012 (H&SC Act) has left an NHS which is "incredibly complex and fragmented" The King's Fund chief executive Chris Ham has said.
Despite this, Ham said that the NHS would not benefit from another top-down reorganisation, but required "reform from within" in order to streamline the health system.
Speaking at a Cambridge University Land Society event in central London, Ham said: "There are examples in some parts of the NHS - for instance Salford Royal NHS Foundation Trust - that are high-performing organisations which have brought about change from within. But these institutions did not become high-performing overnight, or in three to five years. They're still on the journey [and] five to 10 years would be an ambitious timescale [to achieve everything].”
Ham also criticised chancellor George Osborne's announcement of a new social care precept of 2% on council tax. He said the changes would not go far enough given the "very challenging" environment that social care providers were in.
If left unchecked, mounting financial pressure on residential care providers would "create a greater dichotomy between those self-funders who can afford to buy their own care, and those who are publicly funded. [The latter] will rely on a threadbare safety net which will increasingly be available only in some places".
He added that public-facing domiciliary care operators were facing the issues, and that some were "struggling to make ends meet".