NHS white paper: ‘Equity and excellence: Liberating the NHS’

The coalition government has set out its bold vision for the future of the NHS in a White Paper entitled, “Equity and excellence: Liberating the NHS”. In his oral statement to Parliament on 12 July 2010, the Secretary of State for Health, Andrew Lansley, said that the aim of the reform is to:

  • put patients at the heart of decisions made about their care;
  • put clinicians in the driving seat on decisions about services; and
  • focus the NHS on delivering health outcomes that are comparable with, or even better than, those of our international neighbours.

The White Paper sets out how the government intends to bring about this long term transformation, by focussing on four main principles:

1. Putting patients and the public first.
2. Improvement in quality and healthcare outcomes.
3. Autonomy, accountability and democratic legitimacy.
4. Cutting bureaucracy and improving efficiency.

1. PUTTING PATIENTS AND THE PUBLIC FIRST
The government wants shared decision making to be the norm. Their guiding principle will be “No decision about me without me”.

The aim is to give patients GREATER CHOICE and GREATER ACCESS TO INFORMATION . This will be achieved by:

  • Offering patients a choice over their provider, care and treatment options, including a choice of named consultantled team for elective care by April 2011. 
  • Giving patients the r ight to choose to register with any GP practice, without being restricted by where they live. 
  • Encouraging the use of patient experience surveys and feedback, to help patients make the right choice of hospital or clinical department. 
  • Giving patients greater access to their health records and the ability to share their records with third parties.
  • Strengthening the voice of patients through the development of “HealthWatch” – a new independent consumer champion – at both local and national level.

2. IMPROVING HEALTHCARE OUTCOMES

The government intends to focus on RE DUCING MORTALITY AND MORBIDITY; INCREASING SAFETY and IMPROVING PATENT EXPERIENCE. This will be achieved by:

  • Discarding certain unjustified, “topdown” targets.
  • Implementing a NHS Outcomes Framework by April 2012, which will provide direction for the NHS and a focussed set of national outcome goals. Clinicians, patients and the public will be consulted in developing these outcomes.
  • Expanding the role of NICE to develop quality standards for all main pathways of care.
  • Introducing incentives for providers that deliver excellent care.

3. AUTONOMY, ACCOUNTABILITY AND DEMOCRATIC LEGITIMACY

The government aims to LIBERATE PROFESSIONALS AND PROVIDERS FROM TOPDOWN CONTROL in order to give them GREATER AUTONOMY. This will involve:

  • The devolution of power and responsibility for commissioning services to GP practices , working in local consortia, by April 2013. GP commissioning will be  put on a statutory basis, with powers and duties set out in primary legislation.
  • The creation of an independent NHS Commissioning Board by 2012. The Commissioning Board will allocate NHS resources according to the needs of local areas, support GP consortia in their commissioning decisions and promote patient and carer involvement and choice. It will hold GP consortia to account for their performance and quality.
  • The abolition of strategic health authorities and primary care trusts by 2013. 
  • Limiting the ability of the Secretary of State to micromanage and intervene. 
  • The abolition of the NHS Trust model. All NHS Trusts will become Foundation Trusts within 3 years and there will be a consultation on options for increasing foundation trusts’ freedoms. 
  • Strengthening the power of local authorities to promote local wellbeing, by giving them the power to agree local strategies to bring the NHS, public health and social care together.
  • The creation of a new Public Health Service. Local authorities and the Public Health Service will jointly appoint Local Directors of Public Health to focus on health improvement.
  • Strengthening the role of the Care Quality Commission and developing the role of Monitor – the current regulator of Foundation Trusts.

4. CUTTING BUREAUCRACY AND IMPROVING EFFICIENCY

The government aims to CUT THE COSTS OF HEALTH BUREAUCRACY. Its plans for decentralisation (see section 3) will bring major savings, but the government also intends to:

  • Radically  reduce its own NHS functions and abolish organisations that do not need to exist.
  • Streamline functions that need to remain and impose tight governance over the costs and scope of all its arm’s length bodies.

The NHS aims to release up to £20 billion of efficiency savings by 2014, and has committed itself to reducing NHS management costs by more than 45% over the next four years.

Comment

Reaction to the proposed radical changes has been mixed.  BMA chairman Dr Hamish Meldrum said, “We are looking forward to discussing the details behind these new  initiatives in more depth and playing an active role in the consultations that follow.” However, the GPC chairman, Dr Laurence Buckman, said the White Paper is a “really interesting package”, but that he would welcome more detail on “virtually everything”. In particular, he said that within the government’s GP commissioning plans,
questions remain about what happens if GPs fail and how  GPs will be held accountable.[1]

 

Footnote
[1] Healthcare Republic, “GPC calls for more detail on NHS White Paper Commitments” 12th July 2010


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