Birmingham LINk summary of the government white paper: Equity and excellence: Liberating the NHS

Birmingham LINk summary of the government white paper: Equity and excellence: Liberating the NHS

The White paper is routed in the coalition’s beliefs of freedom, fairness and responsibility. The aim of the coalition is to make the NHS the envy of the world. There are three central ideas that the government believes will help them to do this:

1. Patients will be granted more choice and control, and be allowed to make decisions about their care.
2. There will be a focus on clinical outcomes. Hospitals will be rewarded based on measures such as cancer survival rates.
3. Front line staff such as doctors and nurses will be given more control and decision making power. 

 
There are many practical changes that have been outlined in the White Paper that will soon be happening, many of which affect those of us involved in Local Involvement Networks (LINks):

Changes that affect LINks:

•  LINks will become local HealthWatch organisations. Local HealthWatch will ensure that views and feedback from patients and carers are an integral part of local commissioning across health and social care.
• Local HealthWatch will be given the additional power to recommend that poor services are investigated.
• HealthWatch will be a community champion and located in the Care Quality Commission (CQC).
• Local HealthWatch will be funded by and be accountable to local authorities. If the local HealthWatch is not performing, the local council will have the responsibility to put in place better arrangements.
• Local authorities will be able to commission local HealthWatch or HealthWatch England to provide advocacy and support for people.
• The national body; HealthWatch England will provide advice, support and leadership to the local HealthWatch organisations.
• HealthWatch England will provide advice to the NHS Commissioning Board, Monitor and the Secretary of State

Putting patients and public first:

• Patients will have more input into decisions about their care and have improved access to information.
• A NHS Commissioning Board will be established. One of its role will be to promote patients and carer involvement.
• There will be increasing amounts of up to date information on safety, effectiveness and experiences.
• More personal health budget pilots will be encouraged.

Improving health outcomes:

• A new NHS Outcomes Framework will be developed. This will include a set of of national outcome goals to be decided by the Secretary of State.
• NICE will have its remit extended to include social care, and will develop quality standards to inform commissioning decisions.
• Providers will be paid according to their performance and payment will reflect outcomes. Payments will be conditional on achieving quality goals.
• PCT responsibilities for local health improvement will transfer to local authorities who will employ the Director of Public Health jointly appointed with the public health service.
• Local authorities will be set national objectives for improving population’s health outcomes. Local authorities will determine how best to secure those objectives.

Autonomy, accountability and democratic legitimacy:

• A health bill will be introduced to give the NHS great freedoms.
• Power and responsibility for commissioning services will be devolved to GPs and their practice teams working in consortia. GP consortia will have the freedom to decide what commissioning activities they undertake for themselves and what they chose to buy in from external organisations including local authorities, private and voluntary bodies.
• PCTs will cease to exist from 2013 and SHAs will be abolished as statutory bodies during 2012/13.
• All NHS trusts will become or be part of a foundation trust. Staff will have the chance to transform their organisation into a social enterprise.
• Public health budget will be ring-fenced and there will be a new health premium to promote action to reduce health inequalities.
• Local authorities will be responsible for: promoting integration and partnership working between NHS, social care, public health and other local services; lead joint strategic needs assessments; promote collaboration on local commissioning plans and build partnerships for service changes and priorities.  These functions will replace the current statutory functions of Health Overview and Scrutiny Committees. 
• CQC will act as quality inspectorate across health and social care for both publicly and privately funded care.  Its role will be strengthened with clearer focus on essential levels of safety and quality of providers
• Monitor will be developed from its current role as independent regulator of foundation trusts into an economic regulator for the health and social care sectors from April 2012 with responsibility for all providers of NHS care from April 2013.   Monitor will promote competition, regulate prices where necessary and ensure continuity of services. 

Cutting bureaucracy and improving efficiency:

• NHS management costs will be reduced by more than 45% over the next four years. This will be achieved by replacing PCTs and Practice Based Commissioners with GP consortia, and abolishing the SHAs.
• The Department of Health’s role will become more strategic focusing on improving public health, tackling health inequalities and reforming adult social care.

Next steps:

• The forthcoming Health Bill will support the creation of a new Public Health Service and a programme for public health will be set out in a White Paper later in the year.
• More detailed documents will be published seeking views on the implementation of the policy.
• A commission will report within the year on funding long term care and support and the Law Commission will report on the law underpinning adult social care.  The outputs from these commissions will be set out in a White Paper to be published in 2011 with a view to introducing legislation to establish a sustainable legal and financial framework for adult social care.