Ten things you need to know about the NHS reforms
Peter Hoskin and Jonathan Jones 3:36pm
At last we have it: a defence of the coalition's NHS reforms that is worthy of the name. It came courtesy of David Cameron, speaking on BBC Breakfast earlier, and you can watch it in the video above. Suffice to say, the Prime Minister dwelt on the endemic waste and excessive bureaucracy of the current system, yet he also found room to explain why choice matters, and why it won't leave patients stranded.
But, even then, the performance wasn't perfect. Cameron may have thought he was being disarmingly honest by admitting that his brother-in-law's fellow hospital consultants have qualms about the proposals, but one suspects it has served only to arm his opponents. Downing Street spokesmen have since put out hurried explanations that the PM was trying to "humanise" the issue.
Much of it comes down to the reforms themselves: they do not lend themselves to snappy summary, not least becauase many of them are organisational. For welfare, it's "making work pay". For education, it's "putting parents and teachers in control of schools". For health … well, here's our ten-point summary of the government's prospectus, to hopefully fill in some of the gaps:
1) GP commissioning. By the government's account, "key decisions affecting patient care should be made by healthcare professionals in partnership with patients and the wider
public, rather than by managerial organisations.” To that end, they plan to establish a network of "GP commissioning consortia" by 2013, bringing an end to Primary Care Trusts
(PCTs) and Strategic Health Authorities (SHAs). Under this system, GPs will be members of a consortium which controls budgets and commissions services. But the government is keen to stress that,
“individual GPs or GP practices will not have to take commissioning and financial decisions on their own. The majority of GPs will continue focusing on providing primary care.” GP
consortia will be accountable to the new independent “NHS Commissioning Board”. They will be under a statutory obligation to seek to reduce inequalities in access to healthcare”.
How this works in practice, though, is another matter entirely.
2) Outcomes, not targets. The government's White Paper calls for “a move away from centrally-driven process targets which get in the way of patient care; and a relentless focus on
outcomes and the quality standards that deliver them". While it stresses that processes and structures are vitally important, “they do not need to be micro-managed by central government,
nor to be treated as an end in themselves, rather than the means of meeting the objectives”. And the objectives that the system will judged against? The White Paper lists five broad-brush
"domains" that will be used to measure the success, or otherwise, of the NHS:
i) Preventing people from dying prematurely.
ii) Enhancing the quality of life for people with long-term conditions.
iii) Helping people to recover from episodes of ill health or following injury.
iv) Ensuring people have a positive experience of care.
v) Treating and caring for people in a safe environment and protecting them from avoidable harm.
3) The Secretary of State's role. The role of the Health Secretary will be much more limited under the new system, but he “will remain responsible for the design of the system, the
legislative framework and overall strategic coordination”. The various healthcare organisations will be required to work in partnership and, where they fail to do so, the Health Secretary
will "have a new ability to write formally and publicly to the organisation in question.” Where “the breach in the duty of partnership is significant, is sustained and is having a
detrimental effect on the NHS,” he will be able to impose constraints on the organisation. The bill also sets out the Health Secretary’s role in promoting public health, including
providing “services or facilities designed to promote healthy living” and “financial incentives to encourage individuals to adopt healthier lifestyles”. That's all the Nudge
stuff coming through.
4) Local authorities’ role. The government wants local authorities to have “an enhanced role in supporting the delivery of health and social care service”. By
April 2013, all upper tier local authorities will have to set up a “health and wellbeing board”, consisting of councillors, NHS, public health figures and patient representatives. Local
government will also be responsible for “bringing together the NHS, social care, public health and children’s services” to perform a “joint strategic needs assessment”
(JSNA) and create a “joint health and wellbeing strategy” (JHWS) to address local needs. NHS and local authority commissioners will be legally obliged to consult the JSNA and JHWS when
preparing their services.
5) Watchdog for patients. We already have bodies to champion local views on healthcare. They're called – in typical public sector speak – Local Involvement Networks (LINks).
But now the government wants them to "evolve" in local Healthwatch, "supported and led by Healthwatch England as an independent consumer champion". These organisations,
consisting of local individuals and community groups, will ensure “public involvement in the commissioning, provision and scrutiny of local care services”. Healthwatch will also
“provide advice and information to enable people to make choices about health and social care”.
6) Stronger Foundations. Taking yet another leaf out of Alan Milburn's book, the government wants to "liberate NHS providers" such as hospitals and ambulance services. In practice, this means that they will encourage all NHS trusts to become Foundation Trusts (FTs). And those FTs will be made even more independent from the state, thanks to being able to "rely less on external oversight from Monitor, in its current role as regulator of foundation trusts, and more on their own internal governance." The bill also removes the cap on the income that FTs can make from private patients, which the White Paper calls “both arbitrary and unfair in its effects” (and which does not apply to NHS trusts).
7) “Fair, stable and transparent” regulation. The government will strengthen the Care Quality Commission’s (CQC) role in ensuring “essential levels of safety and quality” from providers. Its scope will be extended to primary care providers, such as GPs, and its responsibility for assessing NHS commissioners will be transferred to the NHS Commissioning Board, to allow CQC to focus on regulating providers. The non-departmental body Monitor will become an economic regulator for providers, and will carry out three core functions: promoting competition; regulating prices; and securing continuity of supply where there is no alternative provider.
8) Cutting admin costs. The government plans to cut extraneous administration costs by: removing layers of management (such as PCTs); culling the number of arms-length bodies from 18 to 8 by 2013-14; cutting out duplication of services; and removing some functions from the national level entirely. In this way, it hopes to save £1.9 billion a year by 2014/15.
9) Culture change. The government has coined a dreary couplet to describe what patients should expect from the NHS: "no decision about me, without me." Aside from the specific bodies mentioned above, this will require a "culture change," it is said, in the relationship between healthcare professionals and patients. This will be driven "through leadership and action across the health community”.
10) The importance of personal budgets. Personal budgets have operated in social care – with some success – for a while now. So why not extend them throughout the health service? This, at least, seems to be what the government is thinking. According to them, personal health budgets will be managed in one of three ways: a “notional budget, ” where the NHS holds the money for the patient and buys the services on their behalf; a “third party arrangement,” in which an independent organisation holds the money; or a “direct payment," where money is transferred directly to the patient to buy their own services. The White Paper makes it clear that the current pilot scheme (which will conclude in October 2012) is of “high priority” to the government, and commits it to extending personal health budgets nationally if it is successful.
Previous
David Ossitt
January 31st, 2011 4:23pm Report this commentSuperb, brilliant, he had the interviewer over a barrel.
ndm
January 31st, 2011 4:54pm Report this commentI was struck by the following:
-- key decisions affecting patient care should be made by the healthcare professionals in partnership with patients and the wider public
But who is this "wider public?" I hope it is not the pressure groups that ensure that too much attention is focussed on certain diseases because they are easy to raise funds for. Some of that derided management is needed to defend the system from that kind of problem.
-- According to them, personal health budgets will be managed in one of three ways: a "notional budget," - where the NHS holds the money for the patient and buys the services on their behalf; a "third party arrangement," in which an independent organisation holds the money; or a "direct payment," where money is transferred directly to the patient to buy their own services.
That "third-party arrangement" smells strongly of the insurance providers who have wreaked havoc on the US healthcare system in recent years.
TrevorsDen
January 31st, 2011 5:22pm Report this commentBut ndm - if a facility already exists then why should it not be used?
Why undergo the cost of investing in duplicate facilities.
Perry
January 31st, 2011 5:24pm Report this comment' . the Prime Minister dwelt on the endemic waste and excessive bureaucracy of the current system'
Is it possible for this PR person to stick to the point and speak plainly for a while?
I hope so.
Fatbloke on tour
January 31st, 2011 5:27pm Report this commentPH and your helper
The NHS is called the NHS for a reason, to provide national standards of care throughout the country.
"Health and Wellbeing" boards?
The "Parish" for the 21st century.
GP commissioning = Postcode prescribing.
Personal budgets = Preparing the way for co-pays and top up fees.
Dave the Rave's target for the public services is a basic / cheap universal provision with the option to upgrade using your own money.
It will not be a case of "Easy-Services".
It will be a case of "BA-Services".
Cattle class = Plebs.
World Traveller = Poor end of the Tory vote.
Business class = Upper middle class.
First Class = Gentry / hedgies / Dave's BIL.
Not just health but education and social services as well.
It will be a case of class snobbery hits the public services.
The por will soon have to wear caps so that they can show the right amount of respect when their betters walk past.
Will J
January 31st, 2011 5:41pm Report this commentThis gives me more questions than it answers. It doesn't answer the key question on the purchaser side: how will the consortia avoid becoming just like the PCTs they replace? And on the provider side: who sits on the foundation trusts and why will they do their job of holding the management effectively to account?
I also suspect that the health and well-being boards, having no real power, will be little more than expensive talking shops. As usual, local authorities are being largely excluded from the NHS. Hard to believe that in most other countries local authorities run hospitals. In Sweden they even set the tax and fund it. Democracy anyone?
A J Scott
January 31st, 2011 5:51pm Report this commentI conclude that Fatbloke maintains his consistent turgid output because he is on lifetime medication, which as a taxpayer I do not object to. But could his GP look at him for sending to a lobotomy specialist? not with a view to termination, but to ensuring silence while he watches interminable repetitions of say footage of the miners' strike and Scargill's poetic language.
Pettros
January 31st, 2011 6:06pm Report this commentHow can you say this was a robust defence of the reforms! DC is struggling with the facts himself and you could tell from the interview. By the sounds of it they made the decision to scrap PCTs in a matter of days! madness!
Yosemite Sam
January 31st, 2011 6:10pm Report this comment@ Mr Fatbloke
The NHS has not been a National service since devolution. Health is a devolved responsibility and the devolved administrations choose their own priorities.
Post code lottery is a derogatory term for a positive concept. That is, localities choosing their own priorities. Scotland, Wales and NI do that, as do PCT areas at present. As long as there is a local voice, how otherwise as are priorities to be set? Are the health priorities for Bradford the same as those for Bournemouth? They have different demographics and different reasons for population morbidity. Of course prioritising creates difficult cases, but that does not alter the fundamental sense of that policy.
@ Will J
Even though PCT's set local priorities they are still too large to assess the true scale and variability of local needs. In my own town we have one of the most deprived wards in England and one of the most affluent. GP commissioning will allow for these very local differences.
The constitution of Foundation Trusts was determined by the last government. Any local citizen can join the Foundation and have the right to elect Governors. Governors are also appointed by staff and Local Authorities. How well they do their job is a moot point of course.
ndm
January 31st, 2011 6:25pm Report this commentTrevorsDen -
I didn't understand your reference to "facilities."
Anan
January 31st, 2011 7:19pm Report this commentHealthcare is used - and I would say abused - by far too many of the "working" (or non-working as they became under NewLiebour) class who took it upon themselves to live in as much squalor as they could possibly inflict upon themselves, binge eating, binge drinking, chain smoking and spreading STDs.
They then roll, now after 13 years of Liebour handouts being so obese that this is the only way for them to mobilize, into a hospital with gangrenous legs and burnt out lungs and expect to be treated like god's gift to healthcare professionals. The NHS was set up not as a waste management system for decrepit fatties who resulted from the deliberate and self-righteous acts of defilement by the low class against their own bodies, but rather to help those in real need who were suffering from severe illnesses or afflictions which they had no control over.
It is this usurping of the healthcare system of this country by the unwashed - quite literally - masses of the Labourites which has led it to the dysfunctional state in which we find it.
In addition, the massed ranks of bureaucracy which was created within the NHS and ridiculously called "the managers" by Liebour to provide sustenance to the uneducated, unemployable Labourites who no longer had mines to toil in and who were too proud to clean toilets (leaving these, their ancestral and most suitable jobs, instead to un-integrated foreigners who can barely speak the language of the country - who they then blame for "taking our jobs" and "altering the ethnicity and culture of the country") only added to the problems.
It is time to get the domestos out and rid the NHS of the source of its stench, splitting at the seems with idiot obese managers, of all but the most essential personnel. Also, all the bribes used to keep the most senior members of the establishment in check, in the form of "clinical excellence awards" must be removed.
It is time to restore honesty to this Labour created behemoth, which is, alongside the BBC, one of several large, festering bastions of low-class idiots which are dragging the entire country into the depths of depravity and bankruptcy.
Matron
January 31st, 2011 7:26pm Report this commentThe only two ways to improve the NHS are:
1. Have it serve only the people who have paid for their health insurance for three years.
2. Open it up to competition from private healthcare companies. Deductions should still continue to be compulsory, but the salary/wage earner would nominate which health insurance service he wished to pay into.
No one should be admitted into the UK (except fellow EU members, because we have reciprocal arrangements) without proof of health insurance.
Just as there are machines in airports that dispense travel insurance, so should there be machines that dispense healthcare insurance situated prior to the Immigration area. No health insurance, no entry.
Indeed, airlines should check people's healthcare insurance, as they check passports, pre-boarding, and the way to motivate them to do this is make it compulsory for them to fly back to the port of origin anyone who lands in Britain without insurance.
No insurance, back on the plane.
Paddy
January 31st, 2011 7:39pm Report this commentIt needs a good shake-up from top to bottom.
Ask Andy Burnham and Alan Johnson about the deaths at Stafford Hospital.
You go into hospital nowadays....and if you are lucky enough to come out alive and survive from the filthy wards and being starved of food and water....you end up with another disease.
Bring the matron and nursing sisters back and make sure hygiene is top of the list.
This is what 13 years of Labour have done!
Things can only get better....as Blair used to sing.
Indigo
January 31st, 2011 8:18pm Report this commentAs far as I am concerned, the reforms can't come soon enough. A year ago, I started the process of obtaining from a West Country PCT a Coughlan-compliant full retrospective assessment of my elderly mother's primary health needs. But despite claiming to have held a review panel and an appeal panel, the PCT has yet to produce even one assessment document that has her NHS number on it, never mind a Coughlan-compliant anything. It is a disgusting dereliction of duty, and in most other work spheres this insolence and incompetence would have led to the time-wasters losing their jobs.
Fergus Pickering
January 31st, 2011 9:03pm Report this commentDearie me, what a load of turgid crap from all and sundry. The National Health Service is called National for the same reason the National Theatre is called the National Theatre and the National Debt is called the National Debt. Some wards are dirty. Some wards are clean. Some surgeons are very good. Some surgeons are drunk. Some nures are charming. Some nurses are cows. It's life, don't you know.
London Rob
January 31st, 2011 9:57pm Report this commentSounds great Fatbloke. As it should be.
duncan
February 1st, 2011 9:43am Report this commentof course private sector competition is what it's about. Although the "competition" is unfair. The private sector can avoid/reclaim VAT but bizarrely the NHS has to pay VAT and hence pays 20% of costs of external goods and services back to the state as opposed to shareholders.
Bedblocker
February 1st, 2011 9:53am Report this commentOne of the biggest threats to the future financial stability of the NHS is Fully Funded Continuing Healthcare. This has been highlighted at a recent conference of North Western Primary Care Trust Chief Executives at NHS Wirral.
This new Health and Social Care Bill, far from restricting the minister for health as suggested above, in fact enables him with Henry the VIII powers to make new laws by decree and transfer services at will to the Local Authority where they would be means tested. You will find that the health insurance argument above is a good idea as Matron outlines, but regular insurers will not want to cover you or fund you economically or at all when you are 80+ and suffering from conditions like dementia and Hey, guess what? Neither does the NHS so be prepared to hand over your assets when the knock at the door eventually comes.
Currently, the legal right to fully funded NHS continuing healthcare is a right conferred on us all by the original 1946 health act. This bill, I believe, has the propensity to remove that completely and impose a 100% inheritance tax on NHS continuing care.
Expect to see changes to Continuing Healthcare slipped in through the back door during say, the summer recess when no-one will notice.
In the interim, you will be pleased to know that entitlement to fully funded care, free at the point of need still exists.
If you can afford to take a year or two off work to fight s case (for a sick relative say) and you are a strong minded,tough resilient character, then you stand a chance of getting it. If not, the system will crush you or wear you down as it is designed to do.
What then, is the future for many of us who have paid into the system all our lives, in old age?
michael
February 1st, 2011 10:08am Report this commentA national HEALTH service at last.
- Not an employment agency for labour's bogus Doctors of Corrie and the like.
Bedblocker
February 1st, 2011 1:10pm Report this commentBe advised that currently if you are a failed asylum seeker awaiting deportation (for ever)
You are entitled to Fully Funded NHS Care. However if you are a war hero or ex Spitfire Pilot with Cancer then you are not it seems.
That's what needs addressing, it's not acceptable to further deny the 'Free at point of need' NHS to those that deserve it and have paid for it all their lives.
I fear that this bill will however, do just that and Free Care will not be available in your hour of need or mine.
MR MICHAEL CLEAVER
February 2nd, 2011 12:50pm Report this commentSince this lib/con government has been in power they seem intent on distroying,breaking up OUR NHS yet very few people seem to notice. This latest idea of the health secretary Andrew Lansley making it "FIT FOR THE 21st CENTURY". My worry is, once our NHS has gone, disbanded, distroyed , use what ever expression you like, we will NEVER get it back, this is something the conservatives, in my opinion have been wanting to do for a very long time and people seem to stand by and let these things happen. Both parties in the lead up to the general election said they would not touch the NHS. Seems to me everything they promised in their manifesto they have reneged on, why should we trust them now with the NHS.
Balaams Ass
February 4th, 2011 1:35pm Report this commentNHS = sacred cow
Rebecca
February 18th, 2011 5:34pm Report this commentAnyone who thinks that private competition is the answer hasn't examined the American healthcare system very well. A glance at the US system reveals the most expensive (per capita and % of GDP) healthcare in the world, but not the best outcomes (consistently outperformed by countries like France, Germany, Switzerland etc).
The US system leaves 16% of the population (that's 50 million people, the vast majority of whom work) with no health insurance. A classic example of MARKET FAILURE.
A question to ask: why are private healthcare companies apparently so eager to operate in the UK? Why are they not clamouring to get into the bigger richer German healthcare market where private companies can already operate? It is perhaps because the German market is very tightly regulated and they think the UK will be kinder to them?
Also, what about non-profit healthcare companies/providers like mutual societies? They seem to be missing from this debate. NB: 50% of providers in Germany are non-profit.
Ivor Harrison
May 9th, 2011 11:06pm Report this commentThis will turn the whole country, I would be willing to get Violent over this, the NHS belongs to the People of this Country, like a lot of things that this Tory Goverment is going to do we all roll over & play dead but not with the peoples Health service, it is not perfect but I & others will Fight for this to be stooped,go ahead just try it!! I tell you this-- there will be deep trouble & the vast majority will not take this, I did vote Tory at the last election (& deep down I still am,) but I will feel betrayed by my vote to let Private cherry picking firms to steal my/our NHS, I repeat lets get violent about this enough is enough we all have story,s about how the NHS has helped our friend,s & family , if you dont believe me then just see what happens if they try it out.
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