NHS Reforms

[Joe K]

Subject to the ongoing discussions, this is a precis, by Bren McInerney, of what is being proposed for the Health and Social Care Bill. There is a fair way to go, it seems, before it becomes an Act...

NHS REFORMS AND MODERNISATION

At present there is a listening exercise taking place across the country in order to gather the views from across the country on the co alition governments proposed changes to the NHS captured in the Health and Social Care Bill. There are a number of areas that are being looked at in this listening exercise that include,

1. The role and choice and competition for improving quality of NHS services
2. How to ensure public accountability and patient involvement in the new NHS
3. How new arrangements for education and training can support the modernisation of the NHS
4. How advice from across a range of healthcare professions can improve patient care

Within the Health and Social Care Bill are a number of proposed changes, most notably that clinicians will have a greater say in areas such as purchasing NHS services. In particular, GPs will be part of a consortia that will have a contract with the national purchasing board to buy most (but not all) health services for their local population. In Gloucestershire this will mean 1 GP Consortia for the county, holding around ¾ of a billion pounds for the county, and a representative GP from Gloucester will sit on this board. There are other proposed changes, such abolishing the regional health bodies (that oversee the health service at a regional level), abolishing the present NHS purchasing body (NHS Gloucestershire) and establishing a local Heath Watch that will be responsible for gathering the views, thoughts and experiences of people on all health (children and adults) and social care (adults only) services; providing information to the public on health services; and should the local authority wish to contract the local Health Watch, provide health advocacy services for the local population. People can find more information on this national consultation by visiting www.dh.gov.uk/healthandcare.

The consultation finishes on the 31st of May 2011 and people can respond to the consultation by going on to the Department of Health’s web site www.dh.gov.uk/healthcare by e mailing [e-mail] or writing to the NHS Modernisation Listening Exercise, Room 605, 7a Whitehall, London SW1A 2 NS

[Joe K]

This is a summary of the reform process, from the Telegraph:

How the NHS health reforms got caught in the quagmire


4th January 2010

David Cameron kicks off the unofficial general election campaign - five months before the country goes to the polls - by pledging that he represents "the party of the NHS".

He says: "We are the only party committed to protecting NHS spending. I'll cut the deficit, not the NHS."

He does not mention proposed wholesale changes to its structure or the way it operates.

April 2010

The Conservatives launch their election manifesto, which promises to "back the NHS, which matters more to families than anything"

It does mention a "reform plan", although it omits the more contentious elements of private companies' greater involvement in the NHS and the scrapping of primary care trusts (PCTs) and strategic health authorities (SHAs).

It states: "We will decentralise power, so that patients have a real choice. We will make doctors and nurses accountable to patients, not to endless layers of bureaucracy and management. We can’t go on with an NHS that puts targets before patients."

It goes on: "We need to allow patients to choose the best care available, giving healthcare providers the incentives they need to drive up quality. So we will give every patient the power to choose any healthcare provider that meets NHS standards, within NHS prices. This includes independent, voluntary and community sector providers."

It does mention giving GPs "the power to hold patients' budgets and commission care on their behalf", while also "putting them in charge of commissioning local health services".

Although it promises to "cut the cost of NHS administration by a third" it does not mention scrapping PCTs and SHAs.

May 2010

The Coalition agreement explicitly vows to "stop the top-down reorganisations of the NHS that have got in the way of patient care".

July 2010

Andrew Lansley announces plans to hand the lion's share of the NHS budget, some £60-80 billion, to GPs, as well as scrapping PCTs and SHAs.

Also included in the White Paper, called Equity and Excellence: Liberating the NHS, are plans to allow private companies greater access to the NHS market.

Experts describe the proposed changes as the "the most revolutionary in the NHS since 1948".

Liberal Democrat MPs are taken aback by the proposed structural changes, which appear to fly in the face of the Coalition agreement.

Autumn 2010

Opposition grows among health professionals to the reforms outlined in the White Paper, most stridently against moves to promote competition within the NHS. The BMA argues this would create "waste, bureaucracy and inefficiency".

Clinical specialists also question whether GPs' groups would have the knowledge to commission services properly.

Civitas, the think tank, warns that the reforms have an "unacceptably high" risk of failing and will detract from the more important task of driving up productivity.

January 19, 2011

The Government publishes the Health and Social Care Bill.

February 1, 2011

The Health Bill passes its first Parliamentary test, by 321 to 235 votes, at its second reading. Despite mounting opposition, no Coalition MPs vote against it.

March 2011

Liberal Democrat MPs pass a motion condemning what they call the "damaging and unjustified market-based approach" of the NHS reforms. Put in a difficult position, Nick Clegg says he is in "listening mode".

April 4, 2011

Andrew Lansley tells MPs there is to be "a natural break in the passage of the Bill to pause, to listen and to engage".

A "listening exercise" is set up, chaired by Prof Steve Field, former chairman of the Royal College of GPs, to elicit opinion about how to improve the Bill.

May 2011

Following heavy defeats at the May 5 local election polls and the AV referendum, Nick Clegg changes his tune on NHS reform. He says he will not ask his party to back a "disruptive revolution" in the NHS and starts demanding concessions from the Prime Minister.

June 13, 2011

The Future Forum, the body of health professionals set up to elicit opinion, publishes its recommendations, saying "genuine and deep-seated concerns" need to be addressed.