The Department of Health has published its full response to the NHS Future Forum report, detailing its proposed changes to its plans for the modernisation of health and social care.
A summary of the key changes from the response are outlined below. See full response.
Overall accountability for NHS
Some have raised concerns that the Bill would weaken NHS principles or the Government’s overall responsibility for the NHS. To make clear that this is not the case, we are tabling amendments which will:
- require the NHS Commissioning Board and clinical commissioning groups to take active steps to promote the NHS Constitution, which enshrines the core principles and values of the NHS
- make explicit that the Secretary of State remains fully accountable for the NHS
- create explicit powers for the Secretary of State to oversee and assess the national NHS bodies, to ensure they are performing effectively, while respecting their operational independence.
Clinical advice and leadership
The Forum’s report shows there is universal agreement that patient care is better if it is based on input from those closest to patients – doctors, nurses and other health and social care professionals – in discussion with patients and carers, the voluntary sector, and other healthcare partners.
But we have also heard that, to do this well and really make a difference to patients and carers, we need to be more ambitious. So we will:
- make sure that a range of professionals play an integral part in the clinical commissioning of patient care, including through clinical networks and new clinical senates hosted by the NHS Commissioning Board and stronger duties on commissioners to obtain an appropriate range of clinical adviceensure that at least one registered nurse and secondary care specialist doctor are appointed to clinical commissioning groups’ governing bodies
- embed clinical leadership throughout the new arrangements and support leadership skills to develop
- support clinical commissioning groups to make high quality, evidence-based decisions, with information joining up to support integrated care
- provide more clarity around the proposed arrangements for supporting the development of clinical commissioning groups, authorising them to take on commissioning responsibilities and ensuring ongoing accountability for their role in improving the quality of care.
Public accountability and patient involvement
The Future Forum agrees with us that patients and carers should be at the heart of the NHS, through shared decision making about their care and meaningful involvement in how health services are organised. But the Future Forum also says that if this is to be achieved, more needs to be done to ensure that shared decision making becomes the norm and that new organisations are sufficiently accountable for the decisions they make.
In response to these recommendations, we will:
- strengthen the accountability of new organisations, including clinical commissioning groups
- ensure more joined-up local services by strengthening requirements for close working between health and wellbeing boards and clinical commissioning groups
- strengthen the duties of organisations across the system with regard to patient, carer and public involvement
- strengthen the definition of involvement to reflect better the principle of ‘no decision about me without me’
- ensure that commissioning groups receive a quality premium only where they can demonstrate good performance in terms of quality of patient care and reduced inequalities in healthcare outcomes.
Choice and competition
Nearly everyone who contributed to the listening exercise felt patients should be given more choice and control over their care. Some felt that the competition that accompanies increased choice brought benefits for patients, while others were concerned about its impact on existing NHS providers and integrated services.
The NHS Future Forum said that, while competition has a role to play, the Government should make its position clearer and guard against the dangers of competition being an end in itself. We have heard this message and will improve our plans as follows:
- the Bill will rule out any deliberate policy to increase or maintain the market share of any particular sector of provider – private, voluntary or public
- Monitor’s core duties will be focused on protecting and promoting patients’ interests, not on promoting competition as though it were as an end in itself
- we will keep the existing rules on co-operation and competition in the NHS
- there will be additional safeguards against cherry-picking and price competition
- we will set limits on Monitor’s powers to take action against commissioners
- we will phase in the extension of Any Qualified Provider
- Monitor will be required to enable integration of services for patients
- we will strengthen the duties on commissioners to promote integrated services
- the NHS Commissioning Board will promote innovative ways of demonstrating how care can be made more integrated, including exploring opportunities to move towards single budgets for health and social care
- as recommended by the Forum, the Secretary of State’s mandate to the NHS Commissioning Board will set clear expectations about offering patients choice: a ‘choice mandate’
- we will extend personal health budgets as a priority, subject to evidence from the current pilots.
Developing the healthcare workforce
The NHS Future Forum highlighted that there was strong support for our proposals to improve arrangements for professional development. But they also said that further work is needed to develop detailed proposals following consultation.
We will further develop and revise our plans to make sure we get them right. In particular, we will:
- ensure that Health Education England is in place quickly to provide national leadership and strong accountability, a whole workforce and multi-professional approach, with strong relationships with health, care and education partners
- ensure a safe and robust transition for the education and training system. During transition, deaneries will continue to oversee the training of junior doctors and dentists, and we will give them a clear home within the NHS family
- put in place a phased transition for provider-led networks to take on their workforce development responsibilities when they can demonstrate their capacity and capability
- further consider how best to ensure funding for education and training is protected and distributed fairly and transparently, and publish more detail in the autumn
- ensure high quality management is valued across the NHS, with a commitment to retaining the best talent across the PCTs and SHAs.
Timetable for change
The NHS Future Forum emphasised the need to get the pace of change right, in the best interests of quality and safety. We aim to strike a balance between maintaining momentum and allowing more time to recognise that some organisations may not be ready to take on their full responsibilities on the current timetable. We will make a number of changes to our proposals:
- Primary Care Trusts will cease to exist in April 2013. However, clinical commissioning groups will not be authorised to take on any part of the commissioning budget in their local area until they are ready and willing to do so
- by April 2013, GP practices will be members of either an authorised clinical commissioning group, or a ‘shadow’ commissioning group, i.e. one that is legally established but operating only in shadow form
- where a commissioning group is ready and willing, it will be able to take on commissioning responsibility earlier. Where a group is not yet ready, the local arms of the NHS Commissioning Board will commission on its behalf
- the NHS Commissioning Board will be established by October 2012 to start to authorise clinical commissioning groups, but will only take on its full responsibilities from April 2013
- choice of Any Qualified Provider will be phased in gradually from April 2012
- our expectation is that the remaining NHS trusts will be authorised as foundation trusts by April 2014. But if any trust is not ready by then, it will continue to work towards foundation trust status under new management arrangements. We will further extend, to 2016, the transitional period where Monitor retains specific oversight powers over foundation trusts
- we will ensure a safe and robust transition for the education and training system, and will set out further details in the autumn.
I am very perturbed by paragraph 4.43 of the governments response which deals with the suggestion that where a dispute arises between the local authority and local healthwatch then it should be escalated upwards to Healthwatch England. While conceding that this idea does have some practical problems with its implementation.it was at least an attempt to deal wiht the conflict of interest problem. It is extremely regrettable that the government seems determined to avoid having to deal with the very real conflict of interests problems that the currennt local healthwatch proposals give rise to. This is particularly true as the current proposals would in my respectful submission fundamentally undermine the effectiveness of local healthwatch organisations as they would be unable to command the respect of local communities who would view them as being in the pockets of the local authority and not being concerned with their problems.
If the proposed ‘Duty of Candour’ when things go wrong is to be no more than a ‘contractual’ duty it will have nowhere near the power to underpin a real change in culture and make the culture of denial and cover up which still exists in parts of the NHS a thing of the past. And it does not reflect what patients and others were calling for. What respondents to the listening exercise said, including a coalition of over 200 patients charities, was that there is an urgent need for a statutory duty of candour.
@michael vidal
Well some people seem intent on rubbishing Healthwatch just as they did LINks before. Can’t you people give the rest of the country a chance to get involved? LINks cant get respect if you people continue to publicly undermine them rather than get on with the job of gathering views and involving people in balanced and proportionate involvement in the commissioniong provision and monitoring of services. Rather than publicly undermining them and persisting in condemning things before they have got a chance to get going. Who do you want to fund and run Healthwatch, cos if the tax payer is funding it then I want to make sure HW is accountable as well.
Kevin
On the accountability issue the bill already provides that local Healthwatch is a public body within the meaning of the Public Bodies (Admission to Meetings) Act 1960. It therefore has to have meetings in public, give notice of those meetings and publish and make available its minutes and agendas. In addition it has to make an annual report which is submitted to a number or specified bodies. Furthermore as a statutory corporation it will have to comply with the Companies legislation. Healthwatch is therefore fully accountable.
On the question of funding I would prefer funding to be either direct form the Department of Health or Healthwatch England. I like you want Healthwatch to succeed however I do not believe it can succeed if it is accountable to and funded by local authorities which it has to monitor.
How is the Department proposing to evaluate the impact of these reforms on patient outcomes and NHS costs and when are research contracts to be let for these evaluations?
My concern has been with the public accountability of Foundation Trusts. I am delighted that the Government has listened to The Future Forum in this respect and is now committed to amending the legislation to require FT’s to hold their Board meetings in public.This will be massive help to the public and Foundation Trust Governors up and down the country, provided the amended legislation makes it very clear to FT’s.
The Health Service Circular HSC 1998/207 (applicable to current NHS Trusts) makes it clear beyond doubt on how to open up meetings to the public and it is important that the legislation is drafted with this in mind, otherwise I fear some FT’s will exploit any and every opportunity to avoid the openness that the future forum recommended. Recently a Foundation Trust Governor informed me that the Chair of her Trust (currently holding private Board meetings) had stated that if the Government legislated for FT’s to have open board meetings he would hold ten minute board meetings, such is the reluctance of some, to be open.
I urge the Government to carefully draft the legislation to ensure that this opportunity to improve the legislation through the “listening exercise” is not lost.
Patients/carers who have specialist needs want is to be able to go to a Dr./Clinic of choice and get the treatment they need as and when they need it at their normal hospital. They do not want to go to a GP/ A&E just to get a referal to their normal hospital specialist unit as is happening now because of GPs holding too much of the NHS budget. How are the new systems going to overcome this problem? Or has this been given any consideration at all?