Andrew Lansley Minister of State for Health.
"Equity and excellence: Liberating the NHS
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Last modified date:
12 July 2010
Secretary of State for Health Andrew Lansley today set out the Government's ambitious plans to reform the NHS during this Parliament and for the long-term.
The White Paper ‘Equity and Excellence: Liberating the NHS’ published today, details how power will be devolved from Whitehall to patients and professionals.
Professionals will be free to focus on improving health outcomes so that these are amongst the best in the world. Improving the quality of care will become the main purpose of the NHS.
Patients will get more choice and control, backed by an information revolution, so that services are more responsive to patients and designed around them, rather than patients having to fit around services. The principle will be "no decisions about me without me".
Under the new plans, patients will be able to choose which GP practice they register with, regardless of where they live, and choose between consultant-led teams. More comprehensive and transparent information, such as patients’ own ratings, will help them make these choices together with healthcare professionals.
Groups of GPs will be given freedom and responsibility for commissioning care for their local communities. Providers of services will have new freedoms and they will be more accountable. There will be greater competition in the NHS and greater cooperation. Services will be more joined up, supported by a new role for Local Authorities to support integration across health and social care.
As a result of the changes, the NHS will be streamlined with fewer layers of bureaucracy. Strategic Health Authorities and Primary Care Trusts will be phased out. Management costs will be reduced so that as much resource as possible supports frontline services. The reforms build on changes started under the previous Government.
Health Secretary Andrew Lansley said:
'People voted for change and the Coalition Agreement set out a bold and exciting vision for the future of the NHS – a vision based on the principles of freedom, fairness and responsibility.
'The NHS is our priority. That is why the Coalition Government has committed to increases in NHS resources in real terms each year of this Parliament. The sick must not pay for the debt crisis left by the previous administration. But the NHS is a priority for reform too. Investment has not been matched by reform. So we will reform the NHS to use those resources far more effectively for the benefit of patients.
'The Government’s ambition is for health outcomes – and quality services – that are among the best in the world. We have in our sights a unique combination of equity and excellence.
'With patients empowered to share in decisions about their care, with professionals free to tailor services around their patients and with a relentless focus on continuously improving results, I am confident that together we can deliver the efficiency and the improvement in quality that is required to make the NHS a truly world class service.'
Today’s White Paper is the start of an extensive consultation that will take place over the coming weeks. The Department of Health will shortly be publishing a number of consultation documents to seek views on more detailed proposals.
Notes to Editors
- The White Paper was launched in an Oral Statement to Parliament on 12 July 2010
- Copies of the Oral Statement and the White Paper ‘Equity and Excellence: Liberating the NHS’ are available from the Department of Health Media Centre on 020 7210 5221 and from 3.30pm via the DH website.
PDF version
Key points
- Lord Darzi's NHS Next Stage Review was a key articulation of the previous government's plans for NHS reform. Published in 2008 it set out the government’s plans for NHS reform in England for the next ten years. Its principal focus was on driving up the standards of quality in health care and putting clinicians at the heart of change
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The review was based on reports from strategic health authorities and clinical pathway working groups that presented a vision for change in their particular localities. It was not intended to be a ‘national blueprint’ but a means of enabling these local visions to become a reality.
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One of the chief drivers of improvement proposed was a range of local quality indicators – measuring mortality, complication and survival rates as well as patient perceptions – to enable clinicians to benchmark and improve their performance. A small proportion of trusts’ income were to become conditional on quality indicators and trusts were now obliged to produce annual ‘quality accounts’ similar to their financial accounts. The first set of quality accounts was published in July 2010.
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It proposed a formal constitution for the NHS, which came into effect in March 2010 and spelled out the underlying principles and values of the NHS as well as the rights and responsibilities of patients, the public and staff. Patient rights include the right to any drug or treatment recommended by NICE (National Institute for Health and Clinical Excellence) as well as the right to choose one’s GP.
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Darzi also identified a range of hospital services that could be delivered closer to the patient’s home, including minor surgery and many outpatient consultations, although some services such as stroke and heart disease should be more specialist and centralised. He confirmed his recommendation for 150 ‘GP-led health centres’ to supplement existing services but insisted that the precise range of services provided by these centres would be for local decision and that they would not ‘inhibit any patient’s continuity of care’.
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PCTs together with local authorities were to be responsible for commissioning comprehensive well-being and prevention services, targeting six key goals: tackling obesity, reducing alcohol harm, treating drug addiction, reducing smoking rates, improving sexual health and improving mental health.
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Patients with complex long-term conditions were to be entitled to a named care co-ordinator, such as a community matron, to help them access the services in their personal care plans. Personal budgets for health care, similar to those available in social care, were piloted among 5,000 patients with chronic conditions in 2009.
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The Darzi report was generally well received. But cultural change, which is at the heart of these reforms, is usually a lengthy process and one that can be difficult to measure. The new powers given to clinicians could conflict with the commitments on patient choice and control. And the very different ‘visions’ put forward by SHAs could lead to significant variations in care and further accusations of a ‘postcode lottery’.
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Here are some of the key points from the Structural reform presentation in the White Paper published 12th July 2010.
Over the next parliament -
- Right to register with any GP
- 24/7 urgent care service with new 111 phone number
- Patient held records
- Personal health budgets for people with chronic/long term conditions to start June 2010 ending October 2012
- Establish Heathwatch a new body and voice for patients and public
- Targets going replaced with National health outcome measures
- Reform of payment by results
- Review of the support for hospices
- New Dentistry contract with particular focus on children
- Cancer Drugs Fund Established
- Greater commissioning role for GP's
- Reduction in bureaucracy
- Providers to be set free and reduction in political interference
- Greater role for local government
- Establish Public Health Service
- More access to "talking therapies"
- Share non-confidential information with Home office on knife/gun crime
- Prioritise Dementia research
- 4,200 more Sure Start Health visitors
- Reform funding of social care
- Extend roll out of health and social care personal budgets to give people and carers more control and purchasing power
- Improve access to respite care by using direct payments to carers and better community based provision
- Remove barriers between health and social care funding to incentivise preventative action.
Guidance on direct payments for community care, services for carers and children's services: England 2009
The aim of this guidance is to assist local councils in making direct payments. Together with the Annexes, it also provides guidance on how local councils might manage and administer direct payments. It replaces ‘Direct payments guidance: community care, services for carers and children’s services (Direct Payments) guidance’ issued in 2003. The guidance has been updated to reflect recent legislative changes that extend direct payments to previously excluded groups. An impact assessment and equality impact assessment have been carried out.
- Download Guidance on direct payments for community care, services for carers and children's services: England 2009 (PDF, 960K)
- Download impact assessment (PDF, 9643K)
- Download equality impact assessment (PDF, 187K)
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publicati...
Health Act 2009
Primary care trusts are already able to offer personal health budgets that do not involve giving money directly to individuals. The Health Act – which received Royal Assent on 12 November 2009 – will extend these options by allowing selected primary care trust sites to pilot direct payments. This is part of the wider pilot programme to explore personal health budgets announced in High Quality Care For All.
Regulations and guidance
The Department of Health held a consultation on direct payments for health care and on 29 March 2010, the formal response was published.
Regulations to allow direct payments for health care in pilot sites (under new powers in the Health Act 2009) came into force on 1 June 2010. These regulations will allow direct payments in pilot schemes approved by the Secretary of State.
http://www.dh.gov.uk/en/Healthcare/Personalhealthbudgets/DH_109429
Personal health budgets can be seen as part of a wider drive to personalise public services, which dates back to the 1970s and the campaign by disability groups for people to be allowed to control their own funding. A pilot involving around half the primary care trusts in England is currently underway, testing out personal health budgets in the NHS.
A personal health budget allows people to have more choice, flexibility and control over the health services and care they receive. At the heart of a personal health budget is a care plan, the agreement between the primary care trust and the individual that sets out the person’s health needs, the amount of money available to meet those needs and how this money will be spent.
This section has news and information about personal health budgets, and links to other websites where you can find out more.
http://www.dh.gov.uk/en/Healthcare/Personalhealthbudgets/index.htm
Local authorities will be given statutory responsibility for bringing health and social care together under radical NHS reforms announced by health secretary Andrew Lansley today.
The health White Paper revealed that both primary care trusts and strategic health authorities would be scrapped by 2013.
Consortia of GP practices will take on responsibility for commissioning most health services from PCTs while councils will take on PCTs' public health functions and be charged with leading the integration of health and social care locally.
Care minister Paul Burstow said: "Local authorities will be given access to resources that will be reallocated to the public health aspect of their new role." However, he denied that there would be a substantial transfer of management costs from PCTs to local authorities.
He told Community Care: "What this has done is deepen and strengthen the relationships so the GPs in their consortia, local authorities, social services, children's services and public health responsibilities will come together in one place, working together to deliver the best system, not from the point of view of ministers, but to meet the needs of the local population."
The White Paper states: "Building on the power of the local authority to promote local well-being, we will establish new statutory arrangements within local authorities - which will be established as 'health and well-being boards' or within existing strategic partnerships." It said the boards, to be established by April 2012, would "take on the function of joining up the commissioning of local NHS services, social care and health improvement".
Richard Jones, president of the Association of Directors of Adult Social Services, said the White Paper offered an increased role for local government and a renewed focus on the integration of social care services. "The paper is a positive starting point," he added.
Local authorities will also jointly appoint directors of public health with a national Public Health Service, with directors given control of ring-fenced public health budgets weighted according to the wealth of the local area.
They will have to deliver against a set of between five and 10 quality assurance statements, designed to apply across all health and social care services.
However, the powers of the secretary of state for health will be curtailed to stop "micromanagement" of the day-to-day running of health and social care services.
GP consortia will commission most health services with a few exceptions, including dentistry, community pharmacy and large-scale specialist services.
They will be under a duty to work in partnership with local authorities and will be accountable to an NHS commissioning board which will set standards for services.
Lord Victor Adebowale, chief executive of social care provider Turning Point, said: "Greater fluidity between services not only increases quality and outcomes but has been evidenced to deliver significant cost-savings. We therefore hope that today's rhetoric will become a reality."
The government also announced a wide-ranging review of health and social care regulation today with a view towards significantly reducing the burdens on commissioners and providers.
The White Paper will also mean a change in the role of the Social Care Institute for Excellence, with some of its functions in promoting and disseminating good practice in social care being transferred to a beefed-up National Institute for Health and Clinical Excellence (Nice).
White Paper key points
- A consumer organisation, HealthWatch, will be established within the Care Quality Commission with local branches replacing local improvement partnerships
- There will be an increased role for CQC in monitoring the quality of social care providers
- The government will introduce a choice of providers for some mental health patients from April 2011
- Personal health budgets to be piloted and evaluated before widespread roll-out in 2012
- Monitor, the economic regulator for health, will have its powers extended to govern social care providers
- NHS staff will be encouraged to take control of services as social enterprises. The white paper said it "aims to create the largest social enterprise sector in the world"
- A management budget reduction of 45% from NHS services will be used to fund better care.
GP Michael Fitzpatrick takes a dim view of GP-led commissioning
http://www.communitycare.co.uk/Articles/2010/07/12/114896/Councils-to-be...
When you set this idea alongside plans for practice accreditation, GP revalidation, a revised Quality and Outcomes Framework (QOF), and the benchmarking of performance through balanced scorecards and patient-reported outcomes, you cannot help but reach the conclusion that general practice is undergoing a quality revolution that is likely to significantly challenge and change the nature of its work.
It is because of this increased emphasis on quality improvement in general practice that we commissioned an Inquiry into the Quality of General Practice in England. A key emphasis has been to understand whether quality can be measured across a range of care dimension, how it can be measured and what approaches really lead to sustained quality improvement.
A series of research papers that we commissioned to support the Inquiry are now being published. These have already been debated at a series of seminars with GPs, practice nurses, NHS executives and patient representatives. We hope that you will engage in further debate by leaving your comments on each discussion paper online.
So what have we learnt so far? It is clear that care quality in general practice is generally thought to have improved in recent years, but that more could be done to address the significant variations in care quality that exist. However, most of the studies we commissioned found it hard to make any definitive judgement on care quality in general practice due to a lack of data and information.
A common finding to emerge is that existing measures (such as QOF indicators) are important levers for quality improvement yet do not capture the true essence of care quality. For example, important issues such as care co-ordination and continuity are left unmeasured and undervalued. The Inquiry has spent time working out whether and how this can be redressed. Many of the research papers show that quality of care suffers most when it is poorly co-ordinated, for example, between general practices and other providers.
If general practice is at the heart of the government’s reform agenda, then more needs to be done to enable those working in it to embrace and nurture quality of care. A common response from our seminars was that practices need the time and skills to carry out local audit and peer review to investigate and monitor quality.
As the Inquiry begins to consider these findings, your feedback – particularly if you work in or with general practice – will be important to inform their deliberations on the current state of quality in general practice, how and where this could be improved, and what this means for the future. We invite you to join the debate.
http://benefits.tcell.org.uk/forums/gps-must-embrace-quality-revolution
Future challenges for the NHS: looking ahead to the next five years
read more http://benefits.tcell.org.uk/forums/future-challenges-nhs-looking-ahead-...
The government has revealed proposals for a major shake-up of the NHS system in England.
GPs will be given much more responsibility for spending the budget, while an independent board will be formed to oversee the health service.
GPs lack the expertise to commission care services, when it comes to some conditions, and their proposed new powers could lead to postcode lotteries, campaigners have warned.
The government yesterday published its health White Paper, which included plans to abolish primary care trusts and hand commissioning responsibility for most health and social care services to consortia of GPs working alongside local authorities.
But several charities have warned that GPs lack the knowledge required to carry out this role.
Paul Farmer, Mind chief executive, said: "GPs currently lack the specialist mental health knowledge and training to understand the complexities of mental health commissioning."
He spoke after research published on Monday by mental health charity Rethink found that only 31% of GPs felt equipped to take on the role of commissioning mental health services.
Farmer warned the result could be a "micro-postcode lottery". He argued that access to talking therapies for mental health conditions remained patchy while the number of prescriptions for anti-depressants had risen.
Val Buxton, director of policy at Parkinson's UK, said she didn't want to see inequalities in care provision. She said: "This will only be achieved if GPs are truly accountable to the local community for commissioning services that meet evidence based standards such as Nice [National Institute for Health and Clinical Excellence] guidelines and national service frameworks."
Ruth Sutherland, acting chief executive of the Alzheimer's Society, echoed Buxton's comments and added that GPs would need to have good links with both health and social care services to ensure patients did not fall between the gaps.
GPs would also need to improve their understanding of deafness, old age and end-of-life care to commission effectively, charities said.
Jackie Ballard, chief executive of the Royal National Institute for Deaf People, said: "Our evidence shows that GPs often don't refer patients, especially older people, with hearing loss to audiology services. This means that patients don't get fitted with a hearing aid, and risk becoming socially isolated and withdrawing from employment, which could mean that they develop mental health problems."
Michelle Mitchell, director at Age UK, said GPs often overlooked needs of older patients and this risked age discrimination in the provision of services.
Jonathan Ellis, director of policy at Help the Hospices, said: "Ensuring that people who are dying receive the best care can be the most difficult thing to do. But worryingly, research has shown that GPs are the least confident among doctors in identifying the point at which their patients need end-of-life care." He added that GPs would need support to develop expertise in palliative care.
Related articles
Councils given wide-ranging health powers in NHS shake-up
Adult social care workforce set to double in 15 years
Future of Social Care Institute for Excellence in doubt
Lansley's vision will benefit some GPs but not taxpayers
http://www.communitycare.co.uk/Articles/2010/07/13/114898/Charities-say-...
Primary care trusts were no longer "fit for purpose" and had to go as the price to deliver integrated health and social care, according to care services minister Paul Burstow.
Speaking to Community Care after the government announced the abolition of PCTs, Burstow said most had not "succeeded in delivering integration in many places" despite a few beacons around the country.
Now he said local government should be in the driving seat on integration through councils' new strategic commissioning role as outlined in yesterday's health White Paper, Equity and Excellence: Liberating the NHS.
This laid out a new statutory responsibility for local authorities to take on PCTs' public health functions and to lead on integrating health and social care locally.
This will be through new health and well-being boards or within existing strategic partnerships though Burstow said government did not want to prescribe what boards should look like or who should sit on them.
Consortia of GP practices will take on responsibility for commissioning most health services from PCTs.
The paper also outlined an intention to make it easier and quicker for councils to set up partnership arrangements between health and social care, though it is currently unclear what will happen to existing arrangements between councils and PCTs.
Burstow said: "It [the boards] would be the place where there's an alignment of the commissioning strategies that takes place.
"The commissioning function around social care would still sit within the local authority, but we would expect that smart local authorities would want to make sure that GPs have influence over their commissioning - social care and public health - and indeed they would have influence over GPs commissioning consortia."
He said: "What [the boards do] is deepen and strengthen the relationship because the GPs in their consortia, the local authorities, social services, children's services and public health responsibilities come together in one place to work together to deliver the better system that we want to achieve."
The coalition's programme for government, published in May, had put forward a role for PCTs, purchasing services not commissioned by GPs, and becoming the democratic voice of the NHS, through having some elected board members.
But Burstow added that under the White Paper proposals there was "much stronger accountability across the system locally and integration [was] being really driven in the system".
He said: "I think we've cleared out of the way something [the PCTs] that has not succeeded in delivering integration in many places.
"There are a few beacons around the country that have done it but the beacons have not been bright enough to encourage everyone else to follow that lead so we are now putting in place some very clear frameworks at the local level that really create the opportunity to work together."
Other articles on the health White Paper
Councils to be granted powers over public health
Councils given wide-ranging health powers in NHS shake-up
Future of Social Care Institute for Excellence in doubt
Charities say GPs lack expertise to commission all services
http://www.communitycare.co.uk/Articles/2010/07/13/114899/burstow-pcts-s...
NHS Chief Executive Sir David Nicholson has written to the chief executive community setting out plans to lead the implementation of Liberating the NHS. As the NHS moves at pace to make the Government's vision a reality, it is vital that it continues to deliver on quality, finance and performance, as well as make the required productivity savings of £15-20 billion. This first communication sets out the initial steps that are being taken at a national level to ensure the NHS continues to deliver for today whilst designing a new system for tomorrow. It provides a framework within which Strategic Health Authorities can lead this process regionally, and sets out some initial actions that commissioners and providers need to take as part of state of readiness for 2012
- Download Managing the Transition letter (PDF, 298K)
- Download Managing the Transition letter timeline (PDF, 27K)
http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/De...
Health Secretary, Andrew Lansley MP, made a statement to the House of Commons on 12 July 2010 on the publication of NHS White Paper entitled 'Equity and Excellence: Liberating the NHS'.
- Video and Audio: NHS White Paper
- Commons Hansard: NHS White Paper
- About Parliament: Ministerial statements
- NHS White Paper: Equity and Excellence: Liberating the NHS
Oral statements are made after Question Time (or at 11am on a Friday). Statements usually relate to matters of policy or government actions.
At the end of a statement, MPs can respond or question the government minister on its contents.
http://www.parliament.uk/business/news/2010/07/nhs-white-paper-statement/
There are many good things to take from the White Paper on NHS reform released yesterday. The general thrust behind it - patient choice and clinician led care - is a good one. For too long, politicians have bogged the system down, and healthcare staff conformed to targets set by Whitehall. Yesterday's paper saw the introduction of GP consortia to carry out commissioning, which will be free to buy services from willing providers who will compete to provide services. We've said before that the NHS was too closed off to competition. This story shows how practice-based commissioning could work in practice – and this White Paper goes further than the previous government’s plans.
More good news is that hospitals will all become Foundation Trusts, with the yoke of Strategic Health Authorities (SHAs) removed as they will be abolished. They should therefore have more independence than existing Foundation Trusts. Primary Care Trusts (PCTs) will be scrapped; the White Paper suggests that PCTs add £1 billion of administrative costs to the NHS each year so this is a positive move. So considering that SHAs enforce commissioning on local providers that often know better and PCTs tend to be subservient to the whims of SHAs, in theory two layers of bureaucracy have been removed.
In theory. Because when quangos are removed, their function is often passed off to another body. The PCTs' role in public health has been transferred to local authorities, who must now hire a director of public health; a post with statutory duties. The problem with this is how councils choose to enact the statutory functions - there are often interpretative differences between councils which mean they do drastically different things to perform the duty, often costing more money than is necessary.
Some functions of the SHAs will now be performed by a single body - the NHS Commissioning Board. This new body will be very powerful and it's important, crucial, vital that it will be properly and regularly accountable to parliament and taxpayers.
There will be other new quangos to get to know: HealthWatch England and local HealthWatch bodies will "ensure that the views and feedback from patients and carers are an integral part of local commissioning across health and social care". This is quango-making at its worst. It’s almost as if civil servants sat around a table said to themselves: “How can we prove we are all about patient power? Let’s just make a body to deal with it. And let’s put the words in the name of it together to form a single meaningless word. People like that.” This is an incredibly inadequate solution and no substitute for actual patient power. The Public Health Service will oversee local directors of public health from within the Department of Health – more top-down bureaucracy? Can the Care Quality Commission not perform this task in its revised role as a quality-only regulator?
On pay, the document says:
"Pay decisions should be led by healthcare employers rather than imposed by the Government. In future, all individual employers will have the right, as foundation trusts have now, to determine pay for their own staff. However, it is likely that many providers will want to continue to use national contracts as a basis for their local terms and conditions."
The first two sentences sound great; they are rendered useless by the third. If centralised pay bargaining is retained then the NHS will not be able to tackle its biggest expenditure. As well as being grossly unfair, despite what the unions say, it has serious consequences for patients too. Any reform should address this as a matter of priority and the White Paper fails here.
On IT, there was notable silence over the future of the National Programme for IT – otherwise known as the supercomputer. This expensive and failed project should be scrapped, but the White Paper's omission of it leads one to suspect that it may be sticking around for a while.
Over at the Burning Our Money blog, there are some sound cautionary notes on just how much patient choice there can actually be. It may be hindered as the patient still won’t be the one with the money, so choice could be more limited than we might hope.
Overall though, there are some positive aspects to this document. But transparency will be crucial in all areas and should be the watchword throughout. For example, GP consortia should not be allowed to enter cosy relationships with Providers; contracts between them should be transparent to ensure accountability. And this could even mean more genuine competition and lower costs. Also, as pointed out yesterday, GPs could have a financial incentive that distorts their decisions when advising patients, so transparency will be needed to help offset this risk. Sunlight is the best disinfectant - every doctor knows that.
http://www.taxpayersalliance.com/bettergovernment/2010/07/assessing-the-...
The White Paper is littered with references to consultations. Many detailed questions remain to be answered in further documentation, which is expected to follow. Some of the proposals will need legislative change. The parliamentary process under the coalition government is as yet untested. The Bill is likely to be subject to close scrutiny both within the House of Commons and by the Lords. Some aspects will require renegotiation of contracts with trade unions. At a time when public sector pay is likely to be frozen these negotiations could be protracted. Andrew Lansley is said to be a man in a hurry, yet these issues suggest implementation could be slow.
There is a real danger that the financial squeeze on the NHS, which will start to show within 12 months, could derail implementation of the White Paper. Many providers will become financially challenged, making their ability to go it alone as a social enterprise organisation difficult if not impossible. And any appetite that does exist among GPs to take on commissioning (with support from other organisations, including the private sector) is likely to be dampened by the challenges of having to deliver huge productivity savings.
The other factor likely to make implementation more challenging is that the reform proposals themselves dismantle the very apparatus used in the past to get things done in the NHS – targets and performance management by strategic health authorities and primary care trusts. A reliance on choice and competition and the motivations of professionals and clinicians to drive the changes is a gamble. Our research on patient choice has shown that after several years, it was still having only a limited impact on providers.
If the proposals are to succeed, the government needs to engage and motivate clinicians and managers to work effectively together. They ultimately will lead change across local health economies and deliver improvements in quality and productivity. It is unlikely that managers, who face potential redundancy, and clinicians, who are being given new responsibilities without any increase in pay, will feel ‘liberated’ by the government’s plans. Instead, the government runs the real risk that these structural and organisational changes will distract from the real task of clinically led service change.
Buried in the NHS white paper is the detail that the National Institute for Health and Clinical Excellence (Nice) should "extend its remit to social care". Does this signal the end of the institutional independence of social care?
Well, it's looking alarmingly like the end of the Social Care Institute for Excellence (Scie). Set up in 2001 to identify and spread good practice in the sector, the body has found its stride in recent years after a shaky start. But it now faces the loss to Nice of much of its government-funded work.
Paul Burstow, care services minister, told the Guardian that Nice should set quality standards for the whole of an individual's care experience. It made no sense for its remit to stop at the point on the care pathway at which responsibility for the individual passed from the NHS to social care.
Scie would "continue to have a role, but it won't be the same role they played directly alongside Nice in the past", Burstow said. "Some aspects of that role will transfer to Nice and we are in discussions with Scie about how that will be done."
The picture is complicated by the fact that Scie was created, unusually, as a charity rather than a quango. It is therefore not open to ministers simply to close it down. But it relies on the Department of Health for 91% of its £12m annual income.
Even if Scie survives, however, the decision to extend Nice's writ raises questions about the continued separate identity of social care. The sector has long pressed for the joining-up of health and social care – and the white paper seeks to promote this, particularly through the proposed new role for local government in respect of public health – but the ambition has been on the basis of equal partnership.
Nice's planned move into social care, coming after the collapse last year of the Commission for Social Care Inspection into the Care Quality Commission, suggests that health is being seen very much as the senior partner in this relationship.
Is this the right way round? Figures out this week indicate that the social care sector employed 1.6 million workers in England alone in 2009, an increase of almost 250,000 on a previous estimate for 2007-08. Some of the rise is ascribed to better data collection, but mostly to soaring demand for care services.
The total is significantly higher than that for the NHS workforce, often described as one of the largest in the world, and whereas recruitment in health has been funded by public spending, it is the market that is driving the growth of social care. Of the 1.6 million workers enumerated by Skills for Care, the social care skills agency, 1.2 million are in the private and voluntary sectors.
In business, the acquisition of a big company by a smaller one is sometimes called a reverse merger. Or a reverse takeover.
http://www.guardian.co.uk/society/joepublic/2010/jul/13/will-health-swal...
Commenting on the publication of today’s NHS White Paper, the Chief Executive of The King’s Fund, Professor Chris Ham, said:
‘Today’s White Paper represents one of the biggest shake ups of the health system since the NHS was established. The ambitions it sets out for a more patient-focused, clinically led NHS are the right ones. The lesson of the last decade though is that the impact of the reforms will depend critically on how effectively they are implemented.
‘Giving GPs responsibility for commissioning care and managing NHS budgets should result in services being more closely aligned with patients’ needs. But, while some GPs will seize this opportunity, many others may be reluctant to come forward and lack the skills needed. Setting a deadline for GP consortia to take full financial responsibility for commissioning by 2013 is very ambitious – whether this can be achieved will depend on appropriate support being put in place.
‘The White Paper will accelerate the trend towards a mixed economy in the NHS, with foundation trusts freed up to become social enterprises, opportunities for private companies to support GP commissioning and increased opportunities for independent providers to deliver treatment. The ensuing debate must focus on delivering the best outcomes for patients, providing the most equitable and efficient care and, importantly, ensuring that data is available to measure these outcomes.
‘Proposals to strengthen the links between the NHS and local authorities and give councils an enhanced role in improving public health are positive. The emphasis on linking health and social care budgets is also welcome. With the NHS facing the most significant financial challenge in its history and substantial cuts to social care budgets likely to follow the Spending Review in the autumn, stronger integration between health and social care services is not just desirable, it is essential.
‘The White Paper arrives as the NHS faces the biggest financial challenge in its history – the need to find up to £20 billion in productivity savings to maintain quality and avoid cutting services. The White Paper acknowledges the risks involved in undertaking such wide-ranging reforms. Ministers face a significant challenge in ensuring that effective arrangements are in place to deliver the productivity savings needed and, at the same time, implement the reforms set out in the White Paper.’
http://www.kingsfund.org.uk/press/press_releases/the_kings_funds.html
The NHS White Paper, Equity and excellence: liberating the NHS, sets out the Government's long-term vision for the future of the NHS. The vision builds on the core values and principles of the NHS - a comprehensive service, available to all, free at the point of use, based on need, not ability to pay.
It sets out how we will:
- put patients at the heart of everything the NHS does;
- focus on continuously improving those things that really matter to patients - the outcome of their healthcare; and
- empower and liberate clinicians to innovate, with the freedom to focus on improving healthcare services
The Department is consulting on elements of these proposals. Details on how to respond can be found in the White Paper.
- Download White Paper: Equity and excellence liberating the NHS (PDF, 720K)
- Download analytical strategy for the White Paper and associated documents (PDF, 117K)
- Download initial equality impact assessment (PDF, 150K)
- Secretary of State's statement to the House of Commons, 12 July 2010
- Press release, 12 July 2010
- DH draft Structural Reform Plan
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publicati...
Prime Minister, David Cameron, answered questions from MPs on subjects including Northern Ireland and the National Health Service.
Starting at 12pm, the Prime Minister answers questions from MPs in the Commons for half an hour every Wednesday.
In most cases, the session starts with a routine ‘open question’ from an MP about the Prime Minister's engagements. MPs can then ask supplementary questions on any subject, often one of current political significance.
Opposition MPs follow up on this or another topic, usually led by the Leader of the Opposition, currently Harriet Harman. Normally, she is the only MP allowed to come back with further questions.
http://www.parliament.uk/business/news/2010/07/prime-ministers-questions...
Prime Minister David Cameron and opposition leader Harriet Harman have clashed over the costs of the proposed overhaul of the NHS.
On Monday, Health Secretary Andrew Lansley announced two whole tiers of management would be abolished with GPs given more responsibility for spending.
Ms Harman said the government should be upfront about the cost of the reorganisation.
Mr Cameron did not give a figure, but said the plans were about saving money.
Under the proposals, unveiled in a White Paper, all 10 strategic health authorities and the 152 local management bodies, known as primary care trusts, in England are being axed.
This will be phased in over the next three years.
http://www.publications.parliament.uk/pa/cm201011/cmhansrd/cm100714/wmst...
Andrew Lansley (Secretary of State, Health; South Cambridgeshire, Conservative)
We are today laying before Parliament the Government's response (Cm 7877) to the Health Select Committee report on commissioning, which was published on
The range of the Health Select Committee's inquiry and their report recognise the scale and complexity of the challenge we face. Commissioning is a crucial process in the NHS. It ensures that the health and care services provided effectively meet the needs of the population. It is a complex process with responsibilities ranging from assessing population needs, prioritising health outcomes, procuring products and services to managing service providers.
Since the Health Select Committee's inquiry, there has been a change of administration following a general election in May 2010. The Command Paper published today therefore sets out the present coalition Government's response to the Health Select Committee's fourth report of the session 2009-10.
The White Paper, "Equity and Excellence: Liberating the NHS", published on
The weaknesses in commissioning identified by the Health Select Committee are symptomatic of a system that did not emphasise the importance of clinical involvement in decisions about how the precious resources of the NHS should be spent. We have set out in the White Paper a clear sense of direction, with new rigour and the commitment to put commissioning decisions in the hands of those who are closest to patients themselves-GP practices and other primary care professionals.
Government plans to give healthcare monitoring bodies powers over social care have sparked concerns from sector heads.
The health White Paper, published this week, pledged to extend both the National Institute for Health and Clincial Excellence and Monitor's remits into social care.
Nice will develop quality standards for social care, as it does in health, that would form the basis of outcomes that councils and care providers will be judged against. The government has confirmed it will take some of the Social Care Institute for Excellence's existing roles in developing and disseminating good practice in social care.
Responding to the proposal, Ruth Cartwright, British Association of Social Workers joint manager for England, said: "There has been thoughts that not enough of the staff at Scie, despite them being excellent and hardworking, came from a social work and social care background and we have to be careful that Nice doesn't fall into precisely the same trap."
Monitor, which regulates foundation trusts, will be given a new role as an economic regulator across health and social care, with the power to use competition law to prevent anti-competitive behaviour.
This sparked warnings from Martin Green, chief executive of the English Community Care Association, who said: "I'm concerned that a body that has had little or no exposure to social care will be heavily involved in regulating parts of it."
He added: "I'm also concerned that the experiences of independent providers are not well represented in any of the regulatory bodies."
Jane Ashcroft, chief executive of Anchor Trust, said the experiences of health and social care regulator Care Quality Commission, which has come into criticism for its approach to regulating providers, showed it would be very challenging for both Nice and Monitor to reach across health and social care.
Related articles
Burstow: PCTs scrapped to aid health and social care links
Charities say GPs lack expertise to commission all services
Councils to be granted powers over public health
http://www.communitycare.co.uk/Articles/2010/07/15/114912/sector-concern...
Derek Wanless
- Download publication (pdf 3511kb)
- Download summary (pdf 158kb)
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- 344 pages
- ISBN: 978 1 85717 544 8
Summary
More than one million older people (aged 65 and over) use publicly funded social care services in England. In light of criticism and controversy about the funding of these services, The King’s Fund commissioned Sir Derek Wanless to undertake a review of social care. The review sought to determine how much should be spent on social care for older people in England over the next 20 years and what funding arrangements need to be in place to ensure that this money is available and will produce high-quality outcomes. This report of their findings will make a significant contribution to the debate on the future of social care.
Download contents
The full report and a summary version can be downloaded using the links at the top of this page. As the full report is a very large file (3.5MB), you may prefer to download individual chapters using the links below.
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Title pages (149 kb)
![[pdf]](http://www.kingsfund.org.uk/display_images/document_icons/pdf.gif)
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Summary (158 kb)
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Introduction (96 kb)
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Chapter 1 - The origins and development of social care (205 kb)
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Chapter 2 - Patterns of need for social care (160 kb)
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Chapter 3 - How is the current system performing on services? (216 kb)
- Chapter 4 - How is the current system performing on standards and processes?
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Chapter 5 - How is the current system performing on outcomes? (101 kb)
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Chapter 6 - Who pays what? (579 kb)
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Chapter 7 - Workforce (166 kb)
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Chapter 8 - Informal care (157 kb)
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Chapter 9 - New influences on care (195 kb)
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Chapter 10 - The outcomes needed in 2026? (245 kb)
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Chapter 11 - How should social care funding systems be judged? (97 kb)
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Chapter 12 - Changing the way the system is funded (256 kb)
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Chapter 13 - Assessing the funding options: implications from the model (333 kb)
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Chapter 14 - Discussion and recommendations (125 kb)
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References (154 kb)
- Appendices - the background papers and research papers that form the appendices to this publication are only available on this website. Go to appendices
£4 million boost to give patients control of their health care - Embargoed
A pilot scheme that offers patients more choice and control over their healthcare was given a £4 million boost today by Care Services Minister Paul Burstow.
The money will be used to support personal health budget pilot sites set up and run their pilot schemes.
Personal budgets allow local NHS trusts to put individuals in control of how, where and from whom they receive their healthcare, in partnership with the local NHS.
A personal health budget can either be arranged by the NHS, an independent third party, or the individual can be given the money to buy the care themselves through a direct payment.
Through personal budgets, the Government is giving more power and control to patients – a key them of the Health White Paper Equity and Excellence: Liberating the NHS, which was published on Monday.
Care Services Minister Paul Burstow said:
“I am fully committed to piloting personal health budgets to inform the way we implement them more widely and how we can combine them with social care budgets. We want to give people more choice and influence over their healthcare - giving them direct control of the cash is a powerful way of achieving this.
“A similar scheme has been a huge success in social care, letting people choose services that fit in with their life, rather than fitting their life around the service. Today’s investment into personal budgets for healthcare will ensure that patients using the NHS will be able to benefit in the same way.
“The evidence from social care has shown that people tend to spend less on better things for themselves. Proving that individuals can actually be better guardians of the public purse than institutions, while at the same time ensuring services suit people’s individual needs.”
This commitment comes as a DVD is launched to help councils educate staff and health partners to encourage them to introduce social care personal budgets to existing service users. The DVD shows examples of how successful personal budgets have been in social care.
The DVD reflects the full range of equality and diversity issues and demonstrate different ways of using a personal budget. It also includes an introduction from former GMTV presenter Fiona Philips whose father care was transformed by having a personal budget to meet his social care needs.
Personal budgets in both health and social care give people choice and control over their care and gives them real power to hold services to account.
Fiona Philips said:
“I have two very different experiences. With my mother the personal budget didn’t exist, and we had to fight for everything we got. My mother was carted off to a day centre that she didn’t really want to go to.
“For my father it’s completely changed. Dad has Alzheimer’s so he can’t say what he wants out of his personal budget, and I’ve filled out all the forms. We have a brilliant package for him, which relieves me because I have a small family, I have work, and it’s a real reassurance that he’s being looked after.
“It’s just all the things that keep him living as normal life as possible, maintaining his dignity as well. Just because you are getting older, just because you are disabled, or are very ill have chronic diseases like Alzheimer’s or Parkinson’s doesn’t mean you shouldn’t still be able to maintain your dignity, which is very important.“
Michael Collins, a 27 year old deaf-blind man from Oldham who receives an individual budget via direct payments said:
"Before I felt really trapped. Now that I'm on a personal budget I feel free."
Notes to editors
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The DVD will be available on the new Putting People First website www.puttingpeoplefirst.org.uk which brings together information and tools to help councils and providers personalise their services.
- Direct payments allow Primary Care Trusts to pay the personal budget directly into the patient’s bank account either as a monthly sum or as a one off payment for a piece of equipment. Personal budget can also be held by the Primary Care Trust or by a third party.
- On 28 June the first eight DH personal health budget pilot sites were awarded powers to offer direct payment. Today a ninth site, Hull PCT has subsequently received these powers.
- The £4 million funding for personal health budgets in 2010/11 is at the same level as last year. This is used to provide practical and financial support.
- The Department of Health has today launched new information on the regulations governing direct payments in healthcare, which gives clear advice to help pilots meet the regulatory requirements.
- The first independent interim evaluation report of the personal health budget pilot programme was published today. This is based on interviews with project leads and highlights some of the challenges the pilots face and how they are beginning to overcome these. The main challenges identified include:
· setting the size and scope of the personal health budget, and funding them;
· the care planning process, and supporting people through it;
· linking together health and social care;
· developing the market, so that genuine choices are available to people; and
· managing the cultural change required.
http://nds.coi.gov.uk/clientmicrosite/Content/Detail.aspx?ClientId=46&Ne...
Can we create a fairer adult social care system?
The recent Green Paper shows that the Government has moved on from previous statements on adult social care – but it still lacks important detail, particularly on funding options.
In this Viewpoint, Justin Keen (Professor of Health Politics) and David Bell (Professor of Economics) evaluate the Paper and ask the following questions:
- Is the Government taking steps to ensure that arrangements for the care and support of older people are fair?
- Is the Green Paper detailed enough to determine whether people on different incomes may 'win' or 'lose' under any new set of proposals?
1) How will patients be supported to take greater responsibility and to exercise informed choices?
The coalition government has signalled its intention to put patients at the centre of the NHS and to start an information revolution by publishing more information about quality and outcomes. While patients want to be more involved in decisions about their care and to be supported to make informed choices, professionals are often too busy to do this, do not see this as their role, and believe that patients want them to make decisions for them. How will professionals be motivated and supported to put patients first and involve patients more in decisions? Will patients and professionals be able to make use of the information to drive improvements in care?
2) How will provider competition work in future and what will be the role of the proposed economic regulator?
A mix of competition and co-operation is needed to support the goals of improved health outcomes and enhanced patient experience. Will ministers follow through the logic of competition and allow unsuccessful providers to fail? How will co-operation be supported, for example, to ensure that the providers of unscheduled care work together to reduce duplication and inefficiency? What will be the role of the economic regulator and how will it work with the Care Quality Commission?
3) How will difficult decisions about service reconfigurations and hospital closures be taken in future?
Major changes such as those being implemented in London to address the oversupply of acute hospital beds and duplication of specialist services have taken many years and elaborate processes of public consultation to get to the point of implementation. The impetus for changing services is even greater given the financial context. How will commissioners tackle complex issues like the reconfiguration of tertiary and acute hospital services and how will the views of patients, the public and clinicians be taken into account without them blocking decisions that need to be taken on financial and quality grounds?
4) Will the right incentives and support be in place to ensure enough GPs are motivated to lead the development of GP commissioning and have the competence to do so?
The White Paper will place great emphasis on the devolution of budgets to groups of GPs to enable them to commission care. Previous experience in the NHS has shown that while some GPs are likely to be enthusiastic about this opportunity, many will not be. Will the incentives be strong enough to engage a critical mass of GPs and will they have the leadership and other skills required?
5) How will GP commissioners be held to account for their stewardship of public resources for health care?
If most of the NHS budget is devolved to GP commissioners, it will be essential to be clear who are the ‘accountable officers’ for the resources they control. The proposed independent commissioning board (see below) will not be able to hold to account 500-600 GP commissioning groups, and there will need to be a body sufficiently close to these groups in a position to ensure appropriate and effective use of resources. Who will take on this role? What will be the consequences of failure, and who will ensure continuity of care for registered populations?
6) Who will commission primary medical care and ensure that GPs as providers of care deliver good value for money?
GPs provide primary medical care services under the terms of contracts negotiated nationally and locally, and currently their performance in relation to these contracts is assessed by PCTs. We know that issues such as how well those with long-term conditions are supported by their GPs or the availability of out-of-hours care are not only important to patients but also have a crucial role in reducing avoidable and costly emergency admissions to hospital. Who will take on this responsibility in future? Will consortia of GPs be responsible for the performance of other practices and if so what leverage will they have?
7) What will happen to NHS providers?
The White Paper will need to have a coherent plan for all NHS providers to become foundation trusts. It will also need to offer greater autonomy to high-performing foundation trusts and active encouragement of social enterprise and mutual models. Greater integration of providers should be encouraged where this offers benefits for patients. Will there be a clear vision for the future of NHS providers and how this will be delivered?
8) What will be the future role of PCTs and local authorities?
The coalition agreement signalled that the boards of PCTs will include people who are directly elected as well as members drawn from local authorities. This will help to strengthen local accountability as long as PCTs have a significant role in future. If most commissioning is devolved to GPs, what will be the role of PCTs, and how will they work with local authorities to ensure that cuts in social care do not impact adversely on patients and users?
9) How will the independent commissioning board relate to the Department of Health on the one hand and the NHS on the other?
Distancing ministers from the day-to-day running of the NHS is welcome in principle but how will it work in practice? In the face of any significant clinical failure and result in loss of public confidence in services or organisations, what mechanisms will ensure that politicians remain removed from operational intervention? In the absence of targets, can the board ensure quality is maintained through commissioning standards without reverting to the command and control of past years?
10) How will the government ensure that leaders remain focused on finding £15-20 billion under the QIPP programme while at the same time making far-reaching changes to the organisation of the NHS?
The NHS faces the biggest challenge in its history in delivering financial savings under the QIPP programme. Work on the programme could be derailed by the organisational changes contained in the White Paper and by the loss of experienced leaders as management costs are cut. What transition arrangements will be made to avoid this and to ensure delivery of both QIPP and the White Paper?
http://www.kingsfund.org.uk/blog/ten_challenging.html