The White Paper Building a National Care Service sets out the Government's proposals to build a comprehensive National Care Service for all adults in England with an eligible care need, free when they need it.
- Download Building the National Care Service, White Paper (PDF, 2142K)
- Download Building the National Care Service, Impact Assessment (PDF, 1185K)
- Download Building the National Care Service Equality Impact Assessment (PDF, 180K)
- Shaping the future of care together: report on the consultation
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publicati...
PDF version The JRF welcomes today's long awaited White Paper Building the National Care Service.
JRF Co-Director of Policy and Research, Emma Stone, said: "The JRF has consistently reiterated the need for a care system that is fair, simple to understand, socially and financially sustainable and one that is based on equity - including equity across generations. Today's White Paper proposals set out a clear vision for a national service and funding system that has the potential to meet these criteria, and this must be commended.
Much work needs to be done in the next parliament about exactly how people will pay for this system. Ideas allowing each generation to pay for the costs of its own care in later life are already on the table". (See JRF's recent Hirsch & Spiers Viewpoint for a new Care Levy).
"At a time when tough decisions need to be made to reduce the public deficit there is a huge risk of a loss of momentum on this debate. We urge all the major parties to work together and build public consensus to ensure we have a fair and equitable system in place to deal with one of the biggest challenges of our time.
JRF continues to prioritise this major area of concern and will work with the next government to drive through the changes needed to ensure we have a social care system that is fit for purpose for decades to come."
The White Paper on adult social care is out today. It sets out the government's vision for a National Care Service and a timeline to achieve it … but not until 2015.
The government has opted for the 'comprehensive' funding option. This means everyone who can afford to must pay a 'fair care premium' as their contribution to a new National Care Service. In return, every eligible adult will get free care when they need it, irrespective of where they live in England, with their eligibility determined against nationally consistent entitlements.
It is a bold vision but the trickiest issues have been shelved for now. Perhaps sensibly given the damage caused by electioneering to what needs to be a serious, rational and measured debate.
Exactly how people will pay (and how much, and what the eligibility criteria will be) will be for the next Parliament. A new Commission will make recommendations which will be put to the public vote at the following general election for implementation from 2015.
If by 2015 we have a funding system fit for decades, not just four years, it could be worth enduring another commission on care costs, and more consultations. It is vital to get the system right. But why take so long to deliberate when we already have so much evidence? There is a risk that current interest will evaporate post-election. Isn't there also a risk that the proposal to take the matter of 'how to pay' to the following general election will waste time, and derail any fresh attempts to build cross-party and public consensus?
Our own evidence has consistently called for any funding system to be fair, simple to understand, sustainable. The comprehensive model certainly has the potential to meet these criteria. Much depends on detail to come. I welcome the principles: taking into account people's ability to pay, preferences for how to pay, and intergenerational fairness. These issues are all addressed in Hirsch and Spiers's recent paper on a new deal across generations (proposing a system where each generation pays for its own care costs through a new Care Levy), and Keen and Bell's work on fairness. I welcome the commitment to consider all options already put forward on how people will pay. But there will still be disappointment that a model funded predominantly by general taxation is ruled out as this is widely preferred by people using services.
The White Paper is a step forward: a vision with a timeline, a commitment to driving up quality, and to balancing national entitlements with local flexibility, and a very big to-do list for the major players, including the Care Quality Commission, NHS bodies and Local Authorities. BUT
- Will the changes reduce the big gap between policy and practice? Our evidence shows that personalisation will not be delivered unless there is systemic cultural and values change. Advocacy is worryingly absent.
- Don't we need to think more radically still about care and rights? About how the 'total environment' impacts on support needs? The White Paper shares exciting examples (like collective commissioning) and refers to joining up (with housing). Yet these still feel peripheral, even though we know they are central in people's lives. In contrast, there is heavy emphasis on new structures and frameworks – with the risk that some fundamental issues are untouched.
Community Care website
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The JRF's response to the Law Commission's consultation on creating a simple, consistent, transparent and modern framework for adult social care law.
Get this publication
http://www.jrf.org.uk/publications/law-commission-adult-social-care
The Independent Living Fund (ILF) has responded to the Government's White paper ‘Building the National Care Service'.
In particular the ILF has welcomed the prospect of joined up and predictable support to customers, and the intention to further streamline the way that different funding streams work together to provide people with coherent support.
Stephen Jack, Chair of the ILF Trustees, said, "Our own consultations with 21,000 ILF users across all parts of the UK confirm that above all they want consistent support that they can depend upon.
"Most of our users already receive joined up support from their local authority and the ILF, and we attach great importance to the high satisfaction rates we obtain for customer service to those severely disabled people."
The ILF will play an active role in the Right to Control trailblazers, as one of the named funding streams. The trailblazers will be an excellent means of testing out how best to draw further funding streams into an integrated system, and to simplify processes still further for the customer.
Stephen Jack explained, "The ILF already brings the critical elements of national consistency, portability of support, and links to the benefit system, to the locally driven arrangements that otherwise characterise care funding in the UK. These are central features of the new proposals."
ENDS
For more information contact David Smith, on 0115 9450730 or 07779 083493.
Notes to editors
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The Independent Living Fund (ILF) is an Executive Non-Departmental Public Body of the Department for Work and Pensions. It awards payments to severely disabled people to support the cost of their personal assistance, enabling them to live fully inclusive independent lives in their communities. To get payments from the ILF you have to meet certain conditions.
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The ILF provides financial assistance under the terms of a single publicly financed discretionary Trust Deed - The Independent Living Fund (2006), governed by a Board of nine Trustees.
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The ILF currently provides financial support to over 21,000 disabled people in the UK, and has supported over 46,000 disabled people during the last 21 years.
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The allocated budget for ILF for 2010-11 is £348m for Great Britain and £11.2m for Northern Ireland.
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The Government's White Paper, ‘Building the National Care Service' was launched on 30 March 2010. The paper sets out the Government's proposals to build a comprehensive National Care Service for all adults in England with an eligible care need, free when they need it. Visit: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_114922
- The Right to Control is about disabled people having control over the support they need to go about their daily lives. Disabled people who are eligible for support will be told how much money is available to spend on that support. They will be able to decide how the money is spent, by saying what service they want and/or being given money to buy the support themselves. They will have the choice to have as much, or as little, direct control over the money as they are comfortable with. It will be up to each individual to decide what is right for them. You can find out more about the Right to Control at: www.odi.gov.uk/right-to-control
http://www.ilf.org.uk/press_releases/ilf_welcomes_white_paper_proposals/...
http://www.mencap.org.uk/page.asp?id=10624
http://www.cpa.org.uk/cpa/consultation_building_society_for_all_ages.pdf
http://www.in-control.org.uk/greenpaperresponse
http://www.scie.org.uk/news/files/greenpaperresponse.pdf
http://policy.helptheaged.org.uk/NR/rdonlyres/B6AB41D0-BCD3-493D-829C-47...
http://www.rnid.org.uk/mediacentre/press/2010/socialcarewhitepaper.htm
http://www.mssociety.org.uk/get_involved/policy_campaigns/key_issues/soc...
A quarter of British babies born this year are expected to reach 100. In England and Wales 10,000 of us are already centenarians. What does this mean for the future of social care in this country at a time when budgets are being cut?
Many years ago, JRF launched an Inquiry into the Costs of Continuing Care (1996), having clocked that funding would have to increase dramatically to provide care for a growing ageing population. We proposed a social insurance model at the time, along the lines used effectively in many other countries.
The Adult Social Care White Paper in March set out the government's vision for a National Care Service : a 'comprehensive' funding option.
A social insurance model is one option the new Commission for Funding Care and Support will consider alongside plenty of other evidence and ideas. Policy Exchange's recent report – Careless – recommends the King's Fund partnership model, a social insurance model, or a hybrid model combining the best elements of each. Trade-offs will have to be made. General taxation is probably easiest to understand (and widely preferred by service users and some of the general public). But it is not the fairest across generations and there is little political will to even consider general taxation in the current climate of public spending cuts. A care levy offers a very interesting alternative, potentially providing intergenerational fairness and transparency by people contributing via existing taxes like inheritance tax and national insurance.
In Careless, Policy Exchange advocates merging social care budgets into health budgets. This could prove to be more assimilation than integration, of course. Concerns have already been voiced from the social care sector about GPs commissioning social care (which could work brilliantly if your local GP understands and values social care). In advocating the merger of health and social care budgets, Policy Exchange – as with Reform – also remind us the NHS hasn't been free at the point of access for a long time. Voluntary health insurance, top-ups and co-payments already operate in the NHS. (Of course, if you are over 65 you are exempt from many of these.) It is time, they suggest (and I agree) to rethink the future and funding of the NHS – and to do so without starting from the premise that NHS funding, or any other funding stream, should be singled out for protection and ring-fencing at any cost, as the coalition government is doing.
Crucially, though, the nettle none of us has truly grasped is how to align a new funding settlement for care with what people themselves need, want and value. We must start with people's lives, not services.
This necessitates thinking beyond health and social care integration. None of us think of our lives in terms of neat service domains. What about transport, leisure, culture, welfare, housing? (Can someone reassure me that the excellent HAPPI report published last year on Housing our Ageing Population has not been brushed aside?) What about the wider roles of carers, families and communities?
At a time of austerity and cuts, we need a new vision and funding settlement for care and support that is both socially and financially sustainable for all our futures. Central to all of this are people’s needs, wishes and values in later life.
http://www.jrf.org.uk/blog/2010/09/centenarians-care-and-cuts
Following warning from the British Medical Association (BMA) that the government's health reforms could undermine the long-term future of the NHS in England, the Royal College of Nursing (RCN) has raised concerns about the "highly ambitious timescale" that has been set and Unison has pointed out that measures such as scrapping primary care trusts by 2013 weren't in any manifesto or coalition agreement.
The BMA was worried about plans to scrap two tiers of managers and give GPs greater control over more of the NHS budget, saying the changes could affect "stability" in the health service. It also wasn't keen on increasing competition, claiming that GPs would be set against hospitals. Chairman Dr Hamish Meldrum said there was "much that would be potentially damaging", adding: "The BMA has consistently argued that clinicians should have more autonomy to shape services for their patients, but pitting them against each other in a market-based system creates waste, bureaucracy and inefficiency."
RCN general secretary Dr Peter Carter said the government's proposals were untested and if they are rushed through it could impact badly on patient care, adding that changes should be piloted first and should be a gradual process.
"[The plans] show a radical shift in the way healthcare is managed and provided, at a time when the NHS faces some of the biggest financial challenges of its history," he said.
Unison echoed this view, claiming that major changes made in such a short time frame would lead to instability which could damage patient care.
However, Health Secretary Andrew Lansley retorted: "We need a healthcare system where the management of the care of patients is combined with an understanding of how resources are used. Healthcare professionals are best placed to do this and know where resource is needed to improve outcomes for patients."
Patients are being denied potentially better, more timely treatment because of an NHS culture that demands loyalty to the 'family' of NHS hospital providers, according to the think tank Civitas.
In its report 'Refusing Treatment', Civitas said that existing NHS providers use their muscle and connections to keep providing services even when faster, higher quality care is on offer elsewhere. As a result, the benefits of a decentralised and innovative NHS are being denied to patients who have to wait longer for treatment and fail to access the most appropriate services. The report reckoned there was still a culture of supporting local NHS providers, often regardless of the quality of other organisations: NHS, voluntary or private.
The report claimed that surgeons working in NHS hospitals and independently run centres often work more effectively in the latter, delivering a more reliable and punctual service to patients. But inertia in NHS providers, where surgeons can play the 'clinical' and 'NHS family' cards, keeps better working practices from spreading.
Civitas quoted one private provider executive as saying: "I know for a fact that a surgeon in an unnamed NHS trust takes two and a half hours to do a hip replacement that he does in 45 minutes at [one of our hospitals]."
The report also claimed that NHS trust and foundation trust hospitals had used the guise of 'defending the NHS' to bully PCTs into preserving the status quo when better options were available.
One executive is quoted as saying: "PCTs are scared of the providers' political power. They are afraid of putting services out to tender and angering the hospital providers. They are afraid that the hospitals will then go and do something to retaliate that will cause the PCT managers to lose their jobs."
Hospitals were also found to have engaged in predatory pricing by shifting their overheads around to remove costs from services where they want to win competitive contracts, offsetting them onto other services where there was no competition. This practice prevents fair comparisons between healthcare providers, short-changing patients who may then end up with a lower quality, more costly, service.
Co-author James Gubb said: "The coalition government has put a lot of faith in the power of the market to meet the NHS's unnerving productivity challenge. The problem is the coalition isn't addressing the real issues as to why the market currently isn't delivering: the overwhelming power of hospitals and the closed-shop 'we can do it alone because we're the NHS' attitude so prevalent across the organisation."
Former Labour health minister Lord Warner said the report showed that too many NHS personnel are too comfortable or frightened to create the discomfort and public angst that a properly functioning market would bring.
The NHS has a "closed shop mentality" which stops it working well with private health providers, according to a think tank's report.
Civitas says this means some patients miss out on better services.
It said it had evidence that staff from private firms were barred from training courses and snubbed at meetings.
However, a group representing private providers said relations with the NHS had improved significantly and Civitas was over-playing the issue.
The report analyses the success of some of the healthcare reforms introduced under the previous Labour government.
These include the introduction of systems designed to allow NHS hospitals to "compete" for work with each other and with independent providers.
The idea behind this was that competition would produce better value for money for the taxpayer, with patient choice driving up the quality of services.
The Civitas report claims that hospitals put pressure on primary care trusts to maintain the status quo, and used "predatory pricing"; manipulating budgets to make their bids for work seem more attractive.
'Too bleak'
Interviews with dozens of executives from the NHS and private health companies, it said, revealed how the "culture" of the "NHS family" resisted any move towards the free market.
One private executive complained that despite being able to offer a more efficient, cost-effective service, the local NHS "created a cartel" and refused to allow its consultants to work at the private clinics.
The speed and scale of the government's plans for the NHS in England have been questioned by health unions.
The Royal College of Nursing warns of a "highly ambitious timescale", while Unison says some key schemes go beyond the coalition's stated programme.
The unions are responding to plans for a radical reshaping of the NHS which were published earlier this year.
The government says reform is necessary and will give clinical staff a greater say in the NHS.
A timetable for change was set out in a government White Paper and health unions are submitting their responses as the public consultation draws to a close.
Under the proposals, groups of GPs would have to take control of most of the NHS budget by April 2013.
The primary care trusts that manage that money now and the regional tier of the NHS in England would be abolished at the same time.
All hospitals would have to become foundation trusts, which are more independent, by 2014.
Experts have described the changes as the biggest reorganisation of the NHS since its creation.
The King's Fund has called on ministers to reconsider the speed and scale of new health reforms warning of "significant risks" at a time of increasing financial pressures for the NHS.
In its response to the government's health White Paper the think-tank said the case for radical reorganisation had not been made to justify these measures.
Therefore it said reforms should be rolled out more slowly if ministers are to deliver lasting benefits to patients and improve NHS performance.
These criticisms add to attacks on the speed and scale of the reforms and worries about damage to the current integration process, which have come from organisations such as the British Medical Association, the Royal College of GPs and the Local Government Group.
They also serve to increase the pressure on health secretary Andrew Lansley who continues to insist he will stick to the timetable.
The King's Fund said it supported the need for reform and many of the government's proposals.
These include giving GPs a stronger role in commissioning services, extending choice for patients and enhancing the role of local authorities in the public health system.
However, it questioned the need to embark on a fundamental reorganisation of the NHS when health outcomes and public satisfaction have improved in recent years.
The King's Fund said the scale and speed of the reforms will distract attention from finding the efficiency savings needed to maintain quality and avoid cutting services.
Instead it argued that rather than rushing out the reforms ministers should consider working with GPs who are ready to embrace GP commissioning and using their experience to inform the national roll-out, rather than imposing the GP consortia model in all areas of the country by 2013.
Rather than scrapping primary care trusts and strategic health authorities by 2013, it said that NHS structures should be streamlined. Furthermore the system should be designed to encourage increased collaboration alongside competition.
Professor Chris Ham, chief executive of The King's Fund said: "I hope ministers will think again about the plans for implementing these proposals.
"This does not mean putting the brakes on across the board. In some areas, they could in fact move more quickly by beginning to test out and evaluate how key elements of the reforms will work in practice."
http://www.communitycare.co.uk/Articles/2010/10/07/115513/too-far-too-fa...
Also covered at http://www.publicservice.co.uk/news_story.asp?id=14370
The chairman of the health select committee has warned that joint social care and health commissioning could be destabilised by the government's health reform plan.
Stephen Dorrell called on the Department of Health to ensure that responsibility was clearly set out for ensuring the continuity as consortia of GPs took over commissioning from primary care trusts, as prescribed by the health White Paper.
Speaking at a Conservative conference fringe session, Dorrell, a former health secretary, predicted that different commissioning systems would be implemented in different places.
"It's likely that there will need to be different solutions in different parts of the country. The challenge that we as a select committee will put to the government is that someone must own this process," he said.
He suggested that in some areas GPs were likely to make commissioning for some conditions less of a priority.
"What I'm less persuaded of is that every GP in the land is going to be engaged with pathways to care with regard to people with diabetes, or whatever condition."
Tory councillors with social care backgrounds had a mixed response to the White Paper.
Philip Gretton, the portfolio holder for adult social care on Worcestershire Council, said: "We've made great steps forward on joint health and social care budgets. The threat now is that we face working with a number of GP consortia. [Health secretary] Andrew Lansley needs to make sure that GPs work with social care."
However, Jacqueline Slater, who held a similar post on Blackburn with Darwin Council before the Tories lost power there, said she was optimistic the authority's groundbreaking work on joining health and care together could be built upon under a system of GP commissioning.
Dorrell also warned the session that social care could not expect to prosper from the comprehensive spending review.
"There will be some very tough decisions," he said.
http://www.communitycare.co.uk/Articles/2010/10/06/115504/Joint-social-c...
Health Secretary Andrew Lansley has suggested it is full steam ahead for his NHS reforms in England - despite mounting criticisms.
Unions have raised concerns in the past week about the overhaul, which will see GPs given control of NHS purse strings.
The British Medical Association, Unison and Royal College of Nursing questioned the pace and scale of change.
But in a speech to the Conservative Party conference, Mr Lansley said he would not let his reforms be derailed.
He opened his address by comparing his quick action - he published a plan two months after becoming health secretary - to Labour's approach.
Vision
He said it took Labour ministers three years to publish their vision - the NHS Plan which was set out in 2000.
"We want people to be clear, this is a government that is serious about real reform."
And despite the concerns of the unions, he said he would push ahead with his plans once the consultation ends later this month.
“Start Quote
We want people to be clear, this is a government that is serious about real reform”
End Quote Andrew Lansley Health Secretary
"We will not delay in taking action that is necessary."
The white paper, published in July, set out plans to create GP consortiums to take over the running of the health service from local managers.
It said pilots should be in place by the end of this financial year, before full roll out by 2013.
Unions have said the nature of the overhaul - 10 strategic health authorities and 151 primary care trusts are to be abolished - could threaten the savings the NHS has been told to make.
GPs, in particular, have also expressed concern the consortiums could affect the doctor-patient relationship and about the impact of the creeping commercialisation of the health service.
But Mr Lansley said the reforms would help "quality of care we expect".
Unison general secretary Dave Prentis called the overhaul a huge gamble.
He added: "It is a disgrace that Lansley is pressing ahead with his plans.
"Although he says he wants to put patients in the driving seat, these are just warm words. Lansley has not asked the public what they think, nor were these proposals in the Tory manifesto - nobody voted for them."
Meanwhile, Mr Lansley also announced the government was asking hospitals to formally monitor E. coli and MSSA infections.
Both are already recorded on a voluntary basis with figures showing they have been rising in recent years.
The health secretary said he was keen to monitor what the source of these infections were - most will be contracted in the community but using hospital recording is seen as the best way of identifying trends.
Most GPs are not convinced the planned shake-up of the NHS in England will benefit patients, a BBC
poll suggests.
The survey of 827 doctors by ComRes found less than a quarter agreed putting GPs in charge of budgets would lead to a noticeable improvement for patients.
It comes after leading health unions have criticised the pace and scale of the changes over the past week.
Patient groups said ministers must now work to get health staff on board.
Under the proposals set out in a white paper in July, GP consortiums are to be created to take on responsibility for managing local services by 2013. The 10 strategic health authorities and 151 primary care trusts are to be scrapped in the process.
But the plans have caused unease among health professionals.
'Increasing commercialisation'
The British Medical Association, Royal College of Nursing, Royal College of GPs and Unison have all expressed concerns in their responses to the official consultation, which ends later this month.
The unions warned the changes may threaten the efficiency savings the NHS is having to make, while some are worried about what they see as the increasing commercialisation of the health service.
The BMA has also said the changes could threaten the traditional doctor-patient relationship.
The BBC survey was carried out online between 23 and 30 September.
“Start Quote
We need GPs on board for this to work. If they are apathetic we should not go ahead with it, but there is time to deal with the concerns being raised”
End Quote Katherine Murphy Patients Association
It found 25% said they would be willing to take on the extra responsibility of planning and buying health care for their local populations with 57% saying they would not and 18% expressing no opinion.
However, under the plan the government will not need every GP to become involved in management and so having a quarter wanting to do it could suffice.
A majority also felt they were not well prepared to become involved in commissioning care in the following areas - cancer, emergency hospital care, mental health and paediatrics.
However, some of these areas may end up being the direct responsibility of the independent national board.
Meanwhile, seven in 10 said they thought the changes would lead to a greater role for the private sector.
While it could be argued there is still plenty of time to train and prepare doctors, it is the fact that so many GPs are struggling to see how the overhaul will benefit patients that has caused most concern.
Only 23% said it would benefit patients with 45% saying it would not and 32% expressing no opinion.
Katherine Murphy, of the Patients Association, said while she had some concerns about the white paper plans, they also had the potential to benefit patients by empowering them to get more involved in their care.
On the poll results, she said: "It is worrying. We need GPs on board for this to work. If they are apathetic we should not go ahead with it, but there is time to deal with the concerns being raised. The government needs to do this."
Professor Steve Field, president of the Royal College of GPs, said having a quarter willing to take on responsibility for commissioning was "not worrying".
But he added: "One of the challenges for the Departent of Health is that they now have to go out and talk and work with GPs to get them to better understand how they can influence care."
Health Secretary Andrew Lansley said: "The survey is deeply flawed. It does not reflect the government's policy proposals for GP commissioning and therefore can not provide a genuine perspective of GPs' views on the plans.
"That said, if a quarter of GPs - nearly 10,000 of them - offered support for commissioning in response to this survey, it's a powerful indication of the willingness of GP practices to make progress."
He added there was plenty of time for doctors to get ready for the changes before they were fully rolled out.
The government's NHS reforms risk driving health and social care apart unless action is taken to promote joint commissioning, adult care directors have warned.
In its response to the consultation on the NHS White Paper, the Association of Directors of Adult Social Services raised concerns about the possible impact of the abolition of primary care trusts and the transfer of their commissioning responsibilities to new GP consortia by 2013.
It said the change posed "major risks associated with a loss of organisational capacity" at a time when councils faced spending cuts of 25% or more from 2011-15 and the NHS faced having to make productivity gains of £20bn over the same period.
Similar fears were also expressed today by the NHS Confederation and mirror concerns from the King's Fund, the Royal College of GPs and the British Medical Association about the White Paper.
Adass said it said welcomed the opportunities for councils to take a greater leadership role in health through the establishment within local authorities of health and well-being boards, which will oversee health and social care services in local areas.
But it outlined risks to current joint working and joint commissioning arrangements, including from the dismantling of shared boundaries between councils and PCTs with the creation of GP consortia, which are likely to be smaller than PCTs.
Without such arrangements there could be cost implications to councils, it said, and stressed the need for all partners to be fully engaged in the reform process.
President Richard Jones said: "There is a major need to involve existing and new bodies, local authorities, citizens, local communities and providers in co-designing the changes at national, regional and local levels to achieve a different system that delivers different outcomes across health and social care rather than reinventing the system we have worked in to date."
The response added that it was vital that incentives were introduced in the forthcoming NHS outcomes framework for GPs to work collaboratively with social care and local authorities and pointed to concerns that smaller specialist services could be decommissioned by GP consortia.
The NHS Confederation outlined similar risks to joint working arrangements and added there was a need to encourage GP consortia to work together and help providers adjust to changes in demand.
Acting chief executive Nigel Edwards said: "It is imperative that the government does everything possible to address what is a significant list of uncertainties about how the new system will work.
"The fact of the matter is that the government is planning to build a very big new machine - at great pace - but no one can be quite sure what will happen when it is switched on."
Meanwhile, London Councils also backed the benefits of co-terminous boundaries between health and councils in its response to the White Paper.
http://www.communitycare.co.uk/Articles/2010/10/12/115552/nhs-reform-thr...
Something should be done to reduce the risks associated with the government's proposed healthcare reforms, the NHS Confederation has said, pointing out that it will be "exceptionally difficult" to deliver major structural change and to make £20bn worth of efficiency savings at the same time.
Responding to the white paper 'Equity and excellence – liberating the NHS', the confederation said that while its members support the government's objectives of empowering patients and involving clinicians more closely in decision making, there are "significant risks, worrying uncertainties and unexploited opportunities" that need addressing if the plans are to work.
The confederation's acting chief executive Nigel Edwards said: "Empowering patients is clearly the right thing to do. And there are strong arguments for involving clinicians more closely in decisions about the design of care and the management of resources. But these reforms mean radical change, requiring a major shift in culture and the way the NHS does business, as well as a shake up of institutions.
"It is imperative that the government does everything possible to address what is a significant list of uncertainties about how the new system will work. The fact of the matter is that the government is planning to build a very big new machine – at great pace – but no-one can be quite sure what will happen when it is switched on."
Edwards said the health service was about to embark on a hazardous journey at a time when resources were hugely stretched and there was a "very real" real danger of failures in quality of care or finances.
The confederation's main concerns were that GP consortia didn't appear to be clearly accountable to patients and the public, market mechanisms alone won't be adequate to manage the system, achieving integration for patients required a whole system approach, GP consortia needed more influence on primary care and health inequalities, and overlapping outcomes frameworks for health, public health and social care were needed.
The confederation said that GPs must have the capacity and capability to take over commissioning, skills and experience from primary care trusts were likely to be lost, the management burden needed to be reduced from now, and barriers to trusts achieving foundation trust status could stay. These needed to be tackled if the system is to succeed, the confederation said.
The confederation added that it was clear the culture change being proposed would take many years to have an impact, saying there was "insufficient focus on explaining this". It added that the NHS itself was accustomed to a top-down management approach and more needed to be done to explain the shift away from this to help the public, the NHS, the media and MPs to understand its implications.
• The Unite union has said that the coalition's "rush to privatise the NHS" was in breach of the legally-binding NHS constitution.
Unite national officer for health David Fleming said: "The NHS Constitution confirms employees' legal rights and makes pledges and commitments to patients and staff. These must be adhered to by employers. We are campaigning so those rights and pledges are respected and not abused in the blind panic to make damaging cuts and in the cynical rush to dismantle the NHS."
He added: "NHS managers are under intense political pressure to make huge cuts and changes to patient care services. They will try to make these cuts by attacking jobs, pay and terms and conditions. It is clear that if the private sector – which currently controls four per cent of the NHS – greatly expands its activities as ministers want, the NHS constitution will be undermined and legally violated."
The NHS needs strong and effective leaders, especially during a time of great change as it faces the biggest financial challenge in its history, The King's Fund said as it set up a new commission to look into the future of NHS leadership.
Against a backdrop of discussion about the role of frontline clinicians in running health services and questions about the need for managers in the NHS, the commission will look at the current state of leadership and management in the NHS and outline what will be needed to meet forthcoming challenges.
Reporting in the spring of 2011, the commission will look at leadership at all levels – "from the board to the ward".
Chairing the committee will be The King's Fund's chief executive Professor Chris Ham who said: "The NHS spends over £105bn of public money each year and employs around one and a half million people. It needs strong and effective leaders, especially during a time of great change and as it faces the biggest financial challenge in its history.
"NHS managers have come in for a good deal of criticism recently. This commission will aim to move beyond the polarised and divisive rhetoric which sets up managers and clinicians in opposition to each other, to facilitate a debate about the leadership and management the NHS will need in future."
The Government response to Law Commission consultation paper 192. Review of the law on adult social care
The Government has responded to the provisional proposals and questions in the Law Commission's consultation document to update the legislative framework for social care - Paper No. 192 - Adult Social Care
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publicati...
The Secretary of State for Health (Andy Burnham): Today the Government are laying before Parliament the White Paper, “Building the National Care Service “(Cm 7854).
We have listened to the views of the public and stakeholders through the 2008 engagement process and the 2009 Big Care Debate. The Big Care Debate received over 28,000 direct responses, with more than 40,000 people contributing to the debate through further research or events organised by stakeholders. The consultation showed that there was strong support for our vision of a National Care Service and while there was no clear consensus on funding, the comprehensive option was the most preferred. Today we have published an independent summary of the consultation alongside the White Paper and placed a copy in the Library.
We also held a Care and Support Conference last month with the Care and Support Alliance and other key stakeholders. They urged us to push forward with reform and favoured the comprehensive option.
We believe the time has come to build a comprehensive National Care Service. This will be for all adults in England with an eligible care need, providing free care when they need it—whoever they are, wherever they live in England, and whatever condition leads them to need care. It will give everyone the peace of mind that they and their families will be cared for should the need arise, and it will mean that no one need live in fear of losing their home or their savings to pay for care.
The Government’s vision is for a National Care Service that gives people choice and control, and is focused on keeping people well and independent. It will ensure that different parts of the system work better together, with a new duty for NHS bodies and local authorities to deliver integrated care.
Millions of people care for a family member or friend. This is the hallmark of a civilised society. But we must do more to give support to those who provide such care. Building on the carers’ strategy, the National Care Service will support those caring for others by improving the quality of formal care, and working with employers and Job Centre Plus, to help carers to live the life they want to live.
We recognise that building the new National Care Service will be one of the biggest changes to the welfare state since the creation of the NHS. We are also creating it during a period of fiscal consolidation. Reform to social care must be consistent with our plans for fiscal consolidation and reflect the tough decisions that will need to be made in the next spending review. This means we need to build the new service in stages.
The first stage is to create a step change in the provision of services in the home and in our communities. These services are essential if we are to ensure that more people are supported in their homes. Central to this is the Personal Care at Home Bill, to be implemented in 2011, enabling us to provide free personal care for people in their own home for those with the highest needs. The first stage of reform will also see reablement services available in every community, ensuring that there is a service by which people are supported to regain their independence and confidence when they need home care for the first time. As part of the first stage we will push forward with existing reforms that are already delivering real benefits for people such as the dementia strategy, the carers’ strategy and Putting People First.
The second stage of reform, during the next Parliament, will be to put in place the building blocks of a national system of care and support, in particular the establishment of clear, national standards and entitlements. We will introduce a National Care Service Bill early in the next Parliament as a major step forward. From 2014, care entitlements will be extended meaning that anyone staying in residential care for more than two years will receive free care after the second year. The first and second stages together will mean that the most vulnerable in our society, those with the highest needs, will be protected from very high care costs and that many more people will be supported in their own homes.
During the next Parliament, we will take further steps towards the full reform of the system—moving towards the third stage in which the comprehensive National Care Service becomes a reality, with care free when people need it.
To do this will require everyone to contribute through a fair care contribution. So at the start of the next Parliament, we will establish a Commission to help to reach consensus on the right way of funding the system. The Commission will determine the fairest and most sustainable way for people to contribute. It will make recommendations to Ministers which, if accepted, will be implemented in the Parliament after next. The Commission will determine the options that should be open to people so that they have choice and flexibility about how to pay their care contribution. Our expectation is that the Commission will consider all the various options for payment put forward by stakeholders and the public as part of the Big Care Debate and at the Care and Support Conference.
“Building the National Care Service” (Cm 7854) is in the Library and copies are available to hon. Members from the Vote office.
http://www.publications.parliament.uk/pa/cm/cmtoday/cmwms/archive/100330...