Among the reforms laid out in July's white paper, Equity and Excellence: Liberating the NHS, are plans to axe primary care trusts (PCTs) and strategic health authorities, and hand commissioning power over to local GP-led groups.
Public health will come under council control, the funding for which will be ring-fenced. There will also be a requirement for councils to set up partnership groups with local health providers and commissioners, either through newly formed health and wellbeing boards or existing bodies like children's trusts.
"There is not a lot about children's services and how they fit into these reforms in the white paper," says Webber. "Under the new NHS arrangements, GPs will continue to be the gatekeeper for family health, but we know that many GPs do not have the experience or training in paediatrics. Are they really the best placed to have that role?"
It is hoped that the government's public health white paper, due for publication later this year, will shed some light on the issue. "It may be that we find out more about whether children's trusts will ensure there is a good, coherent structure to children's health," Webber says.
She also has concerns about how health visiting will fit into the government's plans. The coalition has pledged to recruit 4,200 new health visitors but is yet to clarify how this will be achieved. It is also unclear whether health visiting budgets will be ring-fenced when cash-strapped councils take over commissioning the service.
Webber is confident the government supports the idea of a health visiting service available to all families. But in reality she sees this being tweaked to fit broader policy ideals such as "helping those in greatest need and a light touch for those who do not need help".
For Webber, the future of safeguarding within children's health is also worrying. Successive serious case reviews into the deaths and serious abuse of children, have revealed that a lack of communication between organisations across the health and social care sectors is a common issue. In introducing and encouraging new organisations and GP-led commissioning groups, Webber says the government needs to ensure that local safeguarding efforts are maintained.
A raft of new groups are set to join the NHS, through the "right to request" initiative, which allows NHS staff to form independent social enterprises themselves. So far, 32 groups, including a family nurse partnership in Derby, have applied to the scheme. With so many parties involved in children's public health, Webber says simply ensuring a GP commissioner or social enterprise has a representative sitting on a local safeguarding board "will not be enough" in some areas, particularly where safeguarding boards and commissioning groups have different boundaries.
"It is all too easy to say safeguarding is someone else's responsibility. But it needs to be a priority for everyone and there needs to be a structure in place to ensure that happens," she says.
NHS staff are well-used to change, having dealt with a range of reforms in recent years. For example, the 2005 restructuring of PCTs saw their numbers reduced and a greater emphasis on joint commissioning with councils. Webber holds that: "change and progress is good, but I would have liked to have seen a more evolutionary pace, giving people time to adapt to new systems and learn what aspects work and what doesn't."
She adds the government cannot afford to forget children during its reforms of the NHS. "We cannot underestimate the effect of lifestyle on health and those lifestyle choices are formed at an early age," she says.
BACKGROUND: A 40-YEAR CAREER IN THE NHS
- Webber began her career in the NHS as a nurse in 1970
- She was the acting director of operations and assistant director of nursing at Nottingham Community Health NHS Trust
- In 2001 she left Nottingham to become director of clinical services at Broxtowe and Hucknall PCT
- She joined the NHS Confederation, which represents NHS trusts, in 2004, first as policy manager before being promoted to deputy policy director 18 months later
- Her policy remit covers children's policy, the elderly, adult social care, public health, local strategic partnerships and PCT issues
