Extend councils’ formal scrutiny powers to cover all NHS funded services: ·
Our strong desire to increase local democratic legitimacy and scrutiny, and to create a level playing field, have led the Government to decide to take the important step of significantly extending the powers relating to the scrutiny functions of local authorities. ·
The Government will now extend the powers of local authorities to enable effective scrutiny of any provider of any NHS funded service. ·
They will include the ability to require any NHS-funded providers or commissioners to attend scrutiny meetings, or to provide information, thus substantially increasing local democratic scrutiny.
Scrutiny will be able to follow the pound to ensure that local authorities are able to scrutinise any provider, irrespective of whether they are from the public, voluntary or private sector.
Enhanced health role for Local Authorities
Local authorities will lead on improving the strategic coordination of commissioning across NHS, social care, and related childrens’ and public health services. Health and Wellbeing boards will bring together the key NHS, public health and social care leaders in each local authority area to work in partnership. This will be a statutory requirement for all upper tier authorities. The core purpose of the new Health and Wellbeing Boards is to join up commissioning across the NHS, social care, public health and other services. There must be a minimum of at least one local elected representative on the Health and Wellbeing Board. Joint Strategic Needs Assessment will provide an objective analysis of local current and future health needs for adults and children. There will be a statutory duty for it to be undertaken by local authorities and GP consortia through Health and Wellbeing Boards and a new legal obligation on NHS and local authority commissioners to have regard for the JSNA in exercising their relevant commissioning functions.
Will place GP consortia and local authorities under a new statutory duty to develop health and wellbeing strategies together through the Health and Wellbeing Boards. The strategy will provide the overarching framework within which commissioning plans for the NHS, social care, public health and other services the Health and Wellbeing Board agrees are relevant and developed.
Creating local consumer champions:
We have recognised the good work of many LINks (local involvement networks), but some patient needs-like support to make choices-are not necessarily being met. These needs will be met by local Health Watch organisations, which led by Health Watch England, will take on additional functions to LINks to serve as an independent consumer champion within the Care Quality Commission.
Health Watch will act as a local consumer champion for patients and will ensure that local patients are heard on a national level. Local authorities will tailor each local Health Watch according to the range of support services already provided to reflect local needs. Local Health Watch will be to scrutinise local care services by escalating concerns about the quality of health and care services to CQC. Health Watch England will agree standards against which local Health Watch organisations and local authorities can benchmark performance and spread good practice.
Any Willing Provider
Everyone should have choice and control over their care and treatment, and choice of any willing provider, wherever relevant. This option was denied to patients under Labour’s “preferred provider” model. In the autumn of 2009, the then Health Secretary, Andy Burnham, said in a speech that “the NHS is our preferred provider”. This represented a U-turn to long-standing Department of Health policy, and a contradiction of a pledge in the Labour Government’s last manifesto. If we want the best services for NHS patients, at the best price for taxpayers, we simply cannot afford to exclude the quality, innovation and efficiency that the third sector and private providers can bring to the table.
One such example excluded under Labour’s “preferred provider” model was the drugs charity Addaction. Their ‘Breaking the Cycle’ programme has been enormously successful and the resultant savings to the state are enormous. Seven months of Breaking the Cycle support for one family costs £1,700. Within eight months, that is likely to have saved the state £20,000. Within two years, it is likely to have saved £148,000. Over the long term, the effects on two generations of that one family could save the state £880,000. The Command Paper reaffirms the Government’s commitment to allowing patients to choose any healthcare provider for the majority of NHS-funded services. Providers will need to deliver care at NHS standards and within the price the NHS is willing to pay The Liberal Democrat Manifesto refers to “Any Willing Provider” by committing to provide “freedom to commission services for example staff co-operatives, on the basis of a level playing field. Providers will need to deliver care at NHS standards and within the price the NHS is willing to pay, bringing an end to the practice under Labour of private providers overcharging the NHS for services.
Key messages:
1. Reform is not an option; it is a necessity: If we are to make patient outcomes truly world-class and respond to rising demand, we must reform the NHS so that it can focus its resources on patients and quality. · Labour are making the case for standing still based on the premise: that if it ain’t broke, why fix it. But Labour are defending a failed status quo. · Under Labour, NHS spending rose to European levels but it was so tied up in red tape it was unable to deliver European levels of quality health care. · If the status quo is right, why are a staggering 23% of cancer patients only diagnosed when they turn up as emergencies? If the NHS was performing at the level of the best in Europe 10,000 lives could be saved every year. Why is it that a patient in this country is twice as likely to die from a heart attack as a patient in France?
2. Putting the NHS on a sustainable financial footing: Our reforms will help put the NHS on a sustainable financial footing through reduced bureaucracy, increased accountability and stronger incentives for quality and efficiency. · In 2009, Labour signed up to Sir David Nicholson’s figure of £15-20billion savings over the next four years. But they still haven’t offered any serious or coherent plan of reform to achieve it. · Andy Burnham, as Shadow Secretary of State for Health; “It is irresponsible to increase NHS spending in real terms within the overall financial envelope.” · Our reforms will cut outdated and costly administrative structures, saving £1billion by 2014/15 which we will reinvest in frontline patient services.
3. An NHS based on the principles of freedom, fairness and local decision accountability: We will reject Labour’s tick box mentality and instead give freedom to professionals to shape services around their patients and focus on improving health outcomes. We will give responsibility to clinicians so that those designing health services understand how to do so based on what their local communities tell them. Diane Abbott, Shadow Health Minister, 2/11/10 “I concede that inequality widened under the previous (Labour) Government”. We will create a fairer system, driving out health inequalities so that all patients have equitable access to services. We are placing patients at the centre of the NHS. Our reforms will mean patients are given more information and choice about their care-in future ‘there will be no decisions about me without me’.
Detailed messages:
The NHS Commissioning Board will have a duty to promote the involvement patients and carers in decisions about the provision of their health services, and should include in their support to consortia, guidance on public and patient involvement. · NHS Commissioning Board and GP consortia will help patients to make choices about their healthcare and utilise the personal health budgets pilot programme. · The Health and Social Care Information Centre will collect data to support the NHS and will have the power to collect data needed from NHS organisations to support patient choice and information. · It is crucial that people know how to make complaints about health services, and that information about the complaints raised is used to improve services-that is why we will be strengthening the Ombudsman’s power to allow information to be shared more widely in investigating concerns. ·
To increase transparency, all GP consortia will publish a constitution against which patients can hold them to account. · In addition, we will create an Accountable Officer role which will oversee compliance of their consortia with its financial duties, promote continuous improvements in the quality of services it commissions and provide good value for money. · We will establish a health and wellbeing board in every local authority so that commissioning across the NHS, social care, related children’s and public health services are integrated and co-ordinated to achieve better health outcomes for their populations ·
Competition will give patients more choice in their healthcare and is a key driver in improving the quality of services they receive. Monitor, the economic regulator, will be given more powers to promote competition where appropriate in healthcare and, at a later date, for adult social care. ·
Taking into account the level of response, commissioning of maternity services will now sit with GP consortia, but with a strong role for the Board to promote quality improvement and extending choice for pregnant women. ·
An NHS Commissioning Board will be created in shadow form during 2011/12. PCTs will support the development of GP consortia; and SHAs will need to support every NHS trust to become a Foundation Trust within the next three years. ·
In helping all trusts to become Foundation Trusts, we are allowing a longer transition period to ensure that a stronger, more transparent approach can be tested before implementation;
1. our programme of GP pathfinders will create a clearer, more phased approach to the introduction of GP commissioning;
2. we are accelerating the introduction of health and wellbeing boards through a new programme of early implementers; and
3. we are phasing the timetable for giving local authorities responsibility for commissioning NHS complaints advocacy services.
Q&A:
You said no more top down restructuring and political meddling with the NHS. You have broken the promise you made in the Coalition Agreement.
This is not a top-down reorganisation: we have set out no central plans for how the NHS should be changed: instead, we are allowing GPs and local communities to take these decisions. Reform is required precisely so that we can create a system in which professionals and patients are empowered to take decisions and politicians are no longer able to micromanage the NHS.
Why change – Commonwealth Fund says the NHS is one of the best health care systems in the world?
Reform isn’t an option, it’s a necessity. With ever increasing demands on our NHS, we must deliver efficiency and quality improvements if we want to sustain and improve services for patients. We are proud of the NHS and its achievements, especially in terms of equitable access. But we should not mistake equity in access for excellence in outcomes. The UK lags behind many international healthcare systems on survival rates – for example for diseases such as cancer or stroke – and a recent OECD report found that if the NHS were to perform as efficiently as the best performing health systems, we could increase life expectancy in the UK by 3 years. Patients deserve the best that we can give them. Our plans to reform the NHS will put patients at the heart of the system, and focus the NHS on achieving outcomes that are among the best in the world.
No compelling evidence that reforms will result in better or more cost-effective care. Plans are untried and untested and are based on ideology rather than evidence.
The reforms build on many previously tried-and-tested models: GP fundholding in the early 1990s; total purchasing in the mid-1990s; and practice-based commissioning in the mid-2000s. The experience of these systems gives us a wealth of evidence on which our reforms are based.
Why create new structures? Why not build and improve on what you already have?
These reforms build on existing structures. For example – GP consortia build on existing practice-based commissioning arrangements and clusters; economic regulation builds on Monitor; and the functions of the NHS Commissioning Board already exist within the Department of Health and the NHS. What we are doing is creating a sustainable framework and stripping out avoidable layers of management. Devolving power to professionals and patients means we can remove SHAs and PCTs.
What will the reforms cost? How much will be saved by these reforms?
There will be one-off costs, which we will set out shortly, but savings will recur year on year. Reducing the costs of administration across the health system by one third in real terms will save £1.9bn per year by 2014/15. These savings will be used to support front-line NHS services. Waiting times are already rising. These reforms will undo what has been achieved in the NHS. They represent a massive risk to patient care. We need a culture of continuous improvement in the NHS. That means ensuring patients get timely and appropriate access to the care they need. Our reforms will deliver this through the publication of waiting times, patient choice, standards in contracts and competition between services. But patients deserve more than just timely access to care. That’s why we are realigning the NHS to focus on patient outcomes, so patients will get optimum care at each stage of their care pathway, not just for one part of it. Median waiting times for patients on consultant-led referral to treatment pathways remain low. Clinical priority must be the main determinant for when a patient is treated and no-one should experience undue delay at any stage of their treatment.
What about the claims made in the Civitas report (published today) that scrapping primary care trusts all in one go will damage patient care?
We recognise the scale of the challenge and we have adapted our transition plans following consultation, creating a clearer more phased approach to the introduction of GP commissioning by setting up a programme of GP consortia pathfinders. This will give the new organisations nearly three years to secure capability.
This is completely the wrong time for reform. In the current financial climate the NHS should be dedicated to making sound efficiencies and improving patient care rather than undergoing costly reforms.
The financial climate is a reason to accelerate reform, rather than not reform at all. The reforms will help put the NHS on a sustainable financial footing through reduced bureaucracy, increased accountability and strong incentives for quality and efficiency. The money saved will be used to improve the quality of NHS services for patients.
How will the NHS deliver £20 billion efficiency savings during a period of massive upheaval?
The scale of the efficiency challenge is such that it can only be met by system-wide reform. Plans to manage QIPP, and plans to manage transition, are in practice one and the same thing. The reforms will help put the NHS on a sustainable financial footing through reduced bureaucracy, increased accountability and stronger incentives for quality and efficiency.
Failed to honour the pledge to provide real terms increases each year to health funding
The Spending Review delivered on the coalition commitment to grow health spending in real terms. Inflation forecasts will change, but our commitment to sustain and to improve NHS services is constant. The NHS budget has not changed and includes funding for social care and reablement — honouring the commitment to protect the most vulnerable in our society. Even under that forecast, overall funding will increase by more than 10 per cent in cash terms over the Spending Review period.
Is the Nuffield Trust correct when it says that the NHS is actually not getting an increase in spend due to the extra billion that is going to social care?
No; the Nuffield Trust is wrong. The NHS is getting an increase over the next four years.
The health select committee says the the Govt’s planned cuts will test the NHS’s limits
The Government is committed to the NHS – to sustain and to improve services in the face of a tough economic climate. But even with this commitment, in order to meet demand and improve the quality of services, the NHS needs to make up to £20 billion of efficiency savings by 2015. Reform isn’t an option, it’s a necessity in order to sustain and improve our NHS. We have been clear that the NHS must cut back on bureaucracy, not on frontline care.
What about the health select committee’s comments on social care – the committee’s report suggests that councils will be unable to avoid reducing levels of care?
The Spending Review confirmed the Coalition Government’s commitment to social care. Next April an additional £1.3 billion of funding will be made available, rising to £2 billion in 2014/15. This funding is on top of the Department of Health’s existing social care grants, which will rise in line with inflation. This additional investment will make it possible to protect people’s access to care, without tightening eligibility. Councils and NHS partners will need to work harder to improve efficiency and achieve improved value for money.
Giving commissioning to GPs will result in a two-tier health service /postcode lottery; treatment availability will depend on where you live.
We are creating greater flexibility for services to be shaped by local needs and the choices of patients, rather than central diktats from Whitehall. Both the NHS Commissioning Board and GP consortia will be under a statutory obligation to reduce inequalities in healthcare provision and will be held to account through the Outcomes Framework and a Commissioning Outcomes Framework for the outcomes they achieve. Where there is evidence that consortia are failing to fulfil their functions the Commissioning Board will have the power to intervene.
What about job losses?
The NHS must make up to £20bn of efficiency savings by 2014, through reducing bureaucracy and working differently. While it is for local Trusts to determine their specific workforce needs, we have made it clear that efficiency savings must not impact adversely on patient care. Every penny saved — including a one third cut in the cost of administration across the health system — must be reinvested in support of front line services and improving quality. SHAs are developing their own workforce plans and will be updating these in the light of the Operating Framework, PCT allocations and tariff details for 2011/12.
This is privatisation of the NHS
We are clear that we are not changing the fundamental basis on which the NHS is funded – out of general taxation. In addition, there is no question of ‘privatising’ the assets of the NHS: the taxpayer investment in the NHS will be secure, and we will not issue shares in it. We have no ideological preference for private sector provision over the NHS – in marked contrast to the previous Government, which set a target for the number of NHS procedures it wanted to see undertaken by the private sector. In addition, the reforms we are implementing will prohibit the possibility of any preferential payments to private sector providers, and ensure that the private sector does not make any undue profits from delivering NHS services. Our policy of ‘Any Willing Provider’ will facilitate patient choice and allow for a range of providers to offer healthcare, which is most likely to bring about innovation and greater responsiveness to patients in community services.
Local democratic legitimacy is a toothless sham – LAs have no power
These proposals are about real strategic influence, not over-ruling each other’s decisions. Picking up on the consultation responses, it is right that Health and Wellbeing boards do not have a right of veto over plans, as that would undermine GP autonomy, and give local authorities the ability to make NHS commissioning decisions that could commit additional expenditure from GP consortia, without local authorities having to take responsibility for that expenditure. Each member of the health and wellbeing board has separate accountabilities, but a shared responsibility to the local community.