Mr Secretary Lansley, supported by the Prime Minister, the Deputy Prime Minister, Mr Chancellor of the Exchequer, Secretary Vince Cable, Secretary Michael Gove, Secretary Eric Pickles, Danny Alexander, Mr Simon Burns and Paul Burstow, presented a Bill to establish and make provision about a National Health Service Commissioning Board and commissioning consortia and to make other provision about the National Health Service in England; to make provision about public health in the United Kingdom; to make provision about regulating health and adult social care services; to make provision about public involvement in health and social care matters, scrutiny of health matters by local authorities and co-operation between local authorities and commissioners of health care services; to make provision about regulating health and social care workers; to establish and make provision about a National Institute for Health and Care Excellence; to establish and make provision about a Health and Social Care Information Centre and to make other provision about information relating to health or social care matters; to abolish certain public bodies involved in health or social care; to make other provision about health care; and for connected purposes.

Bill read the First time; to be read a Second time tomorrow, and to be printed (Bill 132) with explanatory notes (Bill 132-EN).

http://www.theyworkforyou.com/debates/?id=2011-01-19a.856.0

Plans to increase competition in the NHS risk harming the care of vulnerable patients, health professionals warned today as the government published its Health and Social Care Bill.

Clinicians said the proposals risked fragementing services and damaging quality to the detriment of the care of groups such as people with mental health problems.

The bill would mandate GP consortia, which will be responsible for commissioning healthcare, to open up services to tender to any willing provider, so long as they are registered with the Care Quality Commission and economic regulator Monitor. It would also enable providers to compete on price by enabling the government to set a maximum - rather than a fixed - price for some services.

"There is a danger that, in the new system, services will go to the cheapest provider at the expense of quality," warned Dr Laurence Mynors-Wallis, registrar of the Royal College of Psychiatrists. "There is also a danger that, if a multiplicity of providers is delivering different aspects of care, that care may be fragmented and patients may fall between gaps in services."

Dr Hamish Meldrum, chairman of council at the British Medical Association, was also critical: "Forcing commissioners of care to tender contracts to any willing provider, including NHS providers, voluntary sector organisations and commercial companies, could destabilise local health economies and fragment care for patients.

"Adding price competition into the mix could also allow large commercial companies to enter the NHS market and chase the most profitable contracts, using their size to undercut on price, which could ultimately damage local services."

His fears were echoed by the Royal College of General Practitioners.

"The college is concerned that some of the types of choice outlined in the government's proposals run a risk of destabilising the NHS and causing long-term harm to patient outcomes, particularly in cases of children with disabilities, those with multiple co-morbidities and the frail and elderly," said its chair, Dr Clare Gerada.

"While the government has sought to reassure us, we have yet to be presented with sufficient evidence to underpin these reassurances."

Mynors-Wallis also raised concerns about GPs' ability to commission mental health services.

"The college would be dismayed if psychiatrists were not closely involved with local consortia of GPs in the development of mental health services," he said.

http://www.communitycare.co.uk/Articles/2011/01/19/116134/Plans-for-NHS-...

Review of the new arrangements for the NHS proposed in the Health White Paper.

This review, published today by the National Audit Office, summarizes the new arrangements for the NHS proposed in the Health White Paper. The review's purpose is to inform the Public Accounts Committee so that it can take stock of the proposals as they currently stand and discuss their implementation with the Department of Health and NHS.

http://www.nao.org.uk/publications/1011/nhs_landscape_review.aspx

The Health and Social Care Bill proposes fundamental changes to our health service. The Royal College of Physicians will analyse the Bill in detail, and continue to work to ensure the development of a system that delivers quality care for all.

It is right that the health service strives to deliver efficient, innovative and integrated services, focused on the best outcomes for patients and communities. The Royal College of Physicians supports the shift towards a system that puts clinicians and patients in the driving seat, and promotes collaboration between professions and across primary, secondary and social care.

Sir Richard Thompson, President of the Royal College of Physicians said:

“We, like other medical Royal Colleges and the Health Committee, believe that effective commissioning must involve - not just GPs - but the entire clinical community. Although we welcome the duty for Consortia to seek appropriate advice when discharging their functions, we do not believe this goes far enough. In order to ensure patients across the country have access to the services they need and the standards they deserve, we will continue to press for mandated involvement of secondary care specialists in commissioning decisions and structures.

“The scale and pace of change – and the challenge of unprecedented efficiency savings - should not be underestimated. Neither should the risks if we get this wrong. It is vital that reforms are based on solid evidence and open, honest dialogue with those delivering services on the frontline. The RCP remains concerned that the government’s proposals do not fully resolve the issues associated with price competition. There is strong evidence that competition based on price harms, rather than enhances, quality. We are also anxious to ensure that the system builds in effective safeguards to protect against service fragmentation. The fragmentation of services would have detrimental impacts on the very areas the reforms seek to improve: the quality of services, education and training, patient choice, efficiency and equity.

“We look forward to constructive dialogue with government, the Department of Health and partners to address these issues as the Bill progresses“.

Download the full Health and Social Care Bill

http://www.rcplondon.ac.uk/press-releases/full-rcp-response-health-and-s...

http://www.rcplondon.ac.uk/press-releases/rcp-responds-health-and-social...

http://www.rcplondon.ac.uk/press-releases/rcp-comments-health-select-com...

Social care professionals may be still trying to get their heads around the 367-page Health and Social Care Bill published last week, but their health colleagues appear to have already made up their minds.

"Extremely risky and potentially disastrous," chorused six unions representing doctors, nurses, physiotherapists, health visitors and midwives in a letter to The Times published the day before the bill.

The Royal College of Psychiatrists and Royal College of General Practitioners also weighed in with their concerns following the bill's publication.

Their chief target was government plans to open up the NHS to much greater competition, significantly increasing the level of provision by private and voluntary organisations and allowing providers to compete for commissioners' business on price, as well as quality. Unions and health professional bodies fear this will lead to a "race to the bottom" on price, damaging patient care, and handing an advantage to big private companies.

These changes promise to be dramatic, including for social workers.

"I think inevitably any profound change to our health colleagues is going to affect social workers and social care workers because we work so closely together," said Ruth Cartwright, joint manager for England at the British Association of Social Workers. "I can see it all becoming more chaotic."

The government's view is that competition is key to driving up quality and efficiency in the NHS.

"There is very clear evidence from across services and countries that competition produces superior outcomes to centralised management and monopoly provision," the Department of Health's impact assessment on the bill said.

Patients have been able to choose between "any willing provider" in elective acute services, such as routine operations, since 2008, while in some healthcare areas, services are put out to tender.

However, a significant majority of publicly-funded healthcare in England is still delivered by public bodies: NHS trusts, foundation trusts or primary care trust community providers. The government believes that NHS providers have certain advantages - more affordable employee pensions costs, for instance - that enables them to shut charitable and private providers out of the market, to the detriment of patient care.

However, health professionals believe the government's proposals (see box) will have the opposite effect to that desired.

Dr Laurence Mynors-Wallis, registrar of the Royal College of Psychiatrists, said he feared they would fragment mental health services, citing the impact of competitive tendering for drugs services in the past.

"What you've got is a pathway of care that is very fragmented, with one provider for detoxification services, one for social support etc. Writ large across the NHS that would lead to a real deterioration of care. Would you want one provider for community psychiatric nurses? Would you want another one for psychological input? Integrated services could collapse."

Royal College of GPs chair Dr Clare Gerada warned that the government's plans risked "destabilising the NHS and causing long-term harm to patient outcomes, particularly in cases of children with disabilities, those with multiple co-morbidities and the frail and elderly".

Major concerns surround the introduction of maximum prices for certain services, rather than fixed tariffs.

Mynors-Wallis pointed to the risk that this will damage quality, given the need for the NHS to make £15bn to £20bn in savings over the next four years.

"[Maximum prices are] a real worry. When there are billions to be saved how are the commissioners going to save money other than by going for the cheapest bidder?"

Health research body the Nuffield Trust said the decision to allow maximum pricing "had to be reversed". "International evidence shows that price competition in hospital care is associated with a reduction in quality of care," it said.

The government has said quality will be safeguarded by the fact that all providers will have to be registered with the Care Quality Commission - ensuring minimum standards of quality and safety.

But, as the bill starts its journey through Parliament next week, health professionals remain unconvinced, and their concerns are providing a useful line of attack for Labour, whose shadow health secretary John Healey has warned that the bill's purpose "lies in opening up all parts of the NHS to private health companies".

A battle royal is on the cards and social workers will want to pay heed to it.

More from http://healthandcare.dh.gov.uk/

Plans for NHS competition

● Increase significantly the volume of services in which patients have choice over providers, including in mental health, end-of-life care and long-term conditions.

● Introduce maximum, rather than fixed, prices enabling providers to compete on price as well as quality.

● Monitor to become economic regulator with duty to promote competition for NHS-funded services.

● Require commissioners to put certain services out to tender.

● All NHS providers to become foundation trusts with access to loans, but not subsidies, from the taxpayer.

http://www.communitycare.co.uk/Articles/2011/01/24/116160/NHS-market-ref...

There are other paradoxes and contradictions. While the talk, particularly by Liberal Democrats, is of devolution and localism, the Bill creates, in Monitor and the NHS Commissioning Board, two very powerful national bodies with wide-ranging powers to direct and instruct commissioners and providers. In contrast, the Health and Wellbeing Boards within local authorities appear to have very few powers. And although local scrutiny powers are to be strengthened, their effectiveness will depend on whether local councillors have the information and expertise to ask the right questions.

Andrew Lansley has been clear about his intention to hand responsibility for the day-to-day running of the NHS to an independent body – hoping to distance politicians from local scandals and quieten the sound of bedpans in Whitehall. Yet the Bill gives the Secretary of State many reserve powers. As long as the NHS is funded from general taxation, there will have to be public accountability via the Secretary of State to parliament and the public accounts committee will continue to scrutinise whether public money is being spent wisely. And the Secretary of State will presumably be the person to whom local MPs and the public take their concerns when local services are closed.

Much of the Bill is dedicated to establishing a new economic regulator (Monitor) with powers to set prices, enforce competition and (with commissioners) ensure the continuity of ‘designated’ services. It will also be keeping a watchful eye on GPs to make sure their commissioning is fair and transparent. Ministers have given reassurance that the new system will still allow for integration of services. While there are provisions to allow consortia to pool budgets and a duty on the Board to ‘encourage’ consortia to work closely with local authorities, the main responsibility for promoting integration lies with the Health and Wellbeing Boards. They are unlikely to prove a match for the might of Monitor.

The Bill, and the White Paper before it, was heralded by politicians as putting patients at the centre of the NHS. But it is unclear how their voice will be heard. There are no public representatives in the governance of consortia – instead they have a duty to promote patient involvement. And while Monitor will have to promote and protect the interests of patients neither its governance nor functions make it clear how it will do this.

So where does the truth lie in all this? The Bill is vast in scope and sets out a flexible framework of rules and structures. It is therefore difficult to predict where this will  lead; the government themselves have not been clear about their vision. The sweeping powers being given to Monitor suggest the government believes the NHS can be regulated like utilities or telecoms. Yet unlike these industries it is the commissioner and not the customer who pays for services. There is therefore likely to be conflict, and the mechanisms for resolving this are weak. There is little evidence to suggest that a system of independent regulation is any better at resolving the difficult trade-offs between access, quality, efficiency and cost that have to made in a publicly funded health system. I fear that there are difficult times ahead for the NHS and for the politicians pushing through these radical and untested reforms.

Listen to Anna's initial comments on the Health and Social Care Bill

http://www.kingsfund.org.uk/blog/health_bill_debate.html

This month, we published the Health and Social Care Bill, which sets out our plans to modernise the NHS to help it deliver truly world-class care for people. Running right through it is a new deal: we want to give you – the professionals –much more freedom to care for patients in the way you decide is best. It’s why we’re scrapping the targets that interfere too often with your clinical decisions. It’s why we’re letting GPs – working closely with nurses, consultants and other professionals – take control of commissioning. And it’s why we’re taking out two whole layers of management infrastructure – freeing up more money for patient care, on top of the NHS funding increases we have already put in place.

But in return for this freedom from central control, we want the system to answer much more strongly to patients. By empowering patient choice, opening up competition and introducing new ways local people can get involved in shaping services, we want to give people, not politicians, the power to shape and improve the NHS.

This marks an important change in the way our NHS is run, so it’s of course got a lot of media coverage. But as with any big change, some myths have crept in and people are understandably nervous about what it will mean for them. So I want to address some of these concerns here.

Myth number one is that no change is needed at all. I disagree. Despite the best efforts of staff, the NHS does not consistently deliver the patient-centred, responsive care we all want to see. Too often, the decisions of frontline doctors and nurses are over-ridden by a top-down system which doesn’t allow professionals the freedom they need. This is the reason that, despite spending the European average on health, some of the outcomes are poor in comparison. For example, someone in this country is twice as likely to die from a heart attack as someone in France, and our survival rates for cervical, colorectal and breast cancer are amongst the worst in the OECD.

In addition, the NHS faces enormous financial pressures in the years ahead – driven by factors ranging from ageing and obesity, through to the cost of new drugs and technologies. Sticking with the status quo and hoping extra money will meet the challenges is not an option. If we want to deliver better results for patients, we need modernisation.  If we just carry on as we are, we would face a big crunch in two or three years’ time. Change is needed because we are still behind the rest of Europe. We should aim to be the best.

Myth number two is that our plans have come out of the blue. Again, I disagree. This is not a revolution. It’s evolution. GP-led commissioning, patient choice, payment-by-results, Foundation Trusts – they have all existed in one form or another over the past fifteen years. The NHS has always worked with others from the independent sector too, be it social enterprises, charities or private companies. All these changes drew on some simple logic – that clinicians, not managers or politicians, are in the best position to understand the needs of patients. Our plans simply build on those advances. 

Myth number three is that the speed of change is too fast; that we expect GPs to do too much, too soon, and we are not allowing time to trial the plans. But it is more than two years before GP consortia take on full responsibility for commissioning and we have put in place a leadership and development programme to help all GPs who want to take a leadership role to gain the skills they need. Many GPs of course, already have those skills, and 141 new GP consortia have already been set up, each varying in size and shape but all eager to take advantage of these freedoms. They now cover half the country and still more are signing up.

Myth number four is that commissioning will mean GPs spend their time on paperwork and negotiations instead of treating patients. Not true. GP consortia will be given the resources they need to secure the support and expertise to perform the extra managerial and administrative functions. And we know that not all GPs will want to play a leading role in commissioning – that’s one of the reasons why it’s commissioning by consortia rather than individual practices. Our plans simply mean the responsibility for clinical decisions, and for the financial consequences of those decisions, will be brought together. GPs commission care already, and they know best what their patients want, so it makes sense for them to have more control and responsibility.

Myth number five is that GP consortia will be ‘forced’ to use the private sector to help them commission services for patients. Nothing could be further from the truth. Already, the new GP ‘pathfinder’ consortia are working with the best staff in Primary Care Trusts and Strategic Health Authorities to ensure their skills and talents are put to use in the new system. But what we also want is for GPs to be free to get help from anyone they decide they need it from. In Cumbria, for example, GPs work alongside local charities to help ensure services are best able to meet the needs of their patients. That is precisely the sort of innovation we want to enable all over the country.  GPs will be able to work with anyone they wish from specialists in hospitals to nurses in primary care.

I think people will soon look back at a time when doctors and nurses had to answer to the government machine and think: how was it ever like that? Our plans for modernisation will create an NHS that is more open, more local and more personal. They’ll free you to deliver first-class, world-class, services. And they’ll help make our National Health Service the envy of the world. That’s a rich prize – so together, let’s make it happen.

http://www.number10.gov.uk/news/statements-and-articles/2011/01/pm-artic...

Health and social care should be one system pulling together, not two pulling apart. Alison Thomas reports from the recent national conference of directors of children's and adult services

Shared responsibility is the way forward for health and social care, with an end to silos and cost-shunting between different parts of the system. And this new joint approach will be enforced by "clear instructions" from the government to ensure the NHS and community services work together, and funding is not diverted into other areas, Health Secretary Andrew Lansley has said.

"Integrated working is an old message but with new urgency about it now," Lansley told the national conference of directors of children's and adult services.

The spending review had confronted many "painful necessities" including reductions in grants to support local government services, he added. "The potential impact on social care services was a very serious issue for us. There were real concerns that depleting social care would mean reductions to eligibility for care support and would overwhelm the NHS with emergency admissions."

But a "vital settlement" secured for social care would see £800m channelled through the NHS to support social care in the next financial year, with safeguards to see that it reached its intended recipients. "Re-ablement" for patients leaving hospital would receive £1 50m of the new funds.

"That will be backed by new rules where, from next April, NHS trusts will take responsibility for their patients for 30 days after discharge," Lansley said. "That's part of the focus on outcomes – the outcome for a patient is not that they are discharged from hospital but that they are discharged in a fit state, with support, to resume daily living. Aftercare will no longer be an afterthought but will be integral to the outcomes we are looking for."

He said hospital trusts would be required to work with local government to plan such support.

The remaining £650m going to the NHS would be accompanied by "very clear instructions," through a new operating framework to be published in December, setting out specific primary care trust (PCT) allocations to transfer to local
authorities to spend on social care. "PCTs will work with you to agree where the money should be spent, with a shared analysis of need and common agreement on outcomes."

"I think this is the clearest statement ever given by a government that health and social care should be complementary, not conflicting; integrated, not in silos; cost-sharing, not cost-shunting; one system pulling together, not two pulling apart," Lansley said.

The need for joint working and new approaches was underlined by Richard Jones, president of the Association of Directors of Adult Social Services.

"Doing more for less has to be part of the way forward, but we have to be honest – more for less gets you nowhere near delivering on the size of the challenge we face," Jones told the Manchester conference. "So the agenda has to be something different – now is the time for radical change."

Making systems pull together was even more important at a time when resources were contracting, Jones said.

"At times we display astounding lack of under-standing of the interdependency of our roles in serving the same citizens and communities.

"We need a radical realignment of the way we work with health. There is real potential for a new alignment between GPs, local government and the wider public health agenda – a common agenda around prevention, wellbeing, care and support provided close to home."

And Marion Davis, president of the Association of Directors of Children's Services, said local authorities needed to become skilled commissioners of services, rather than necessarily the direct providers.

"The sector will increasingly be made up of different kinds of organisations," Davis said. "We will need integrated working, getting agencies to come together to share resources, staff and expertise and build on the benefits of local partnerships."

http://www.publicservice.co.uk/feature_story.asp?id=15696

Providers have been under significant financial pressure in recent years; if they simply try to do more for the same, this will eventually have an adverse impact on quality, our analysis of the productivity challenge suggests the real opportunities lie in shifting care between sectors and organisations, and in the clinical redesign of services. Some PCTs have tried to lead this process, convening clinicians to redesign care pathways and then using these new pathways as the basis for commissioning. In the absence of any strategic leadership from commissioners, providers themselves will need to come together to agree a common approach to improving the value delivered by the system. In future, market management and the specification of services will be less influenced by local commissioners. GP consortia will not be in a position to specify services; first, they will not have the capacity to do so, and second the transaction costs in the system would simply be too high. Even if they try to do so, large providers receiving patients from many different GP consortia may offer a standard package and manage the risks and costs internally as many large providers in the United States do faced with multiple payers.

In future, although the NHS Commissioning Board will directly commission relatively few services, it will have a significant role in drawing up national service specifications – in line with NICE standards. The contracting model which allows ‘any willing provider’ suggests that as long as a provider (working alone or in partnership with other providers), is able to meet these standards they will be reimbursed at a fixed price. Although there has been discussion about the reintroduction of price competition, in fact the Bill allows Monitor to set a fixed or a maximum price.

It is clear that the tariff will be able to cover two or more services, opening up the possibility of creating payments for pathways of care and even risk-adjusted capitation payments for a ‘year of care’ for a diabetic, for example. If the Commissioning Board and Monitor are creative in how they manage this process, there is a real opportunity to stimulate innovation on the provider side and encourage integrated care. Lead providers could take financial responsibility and then, working with others through joint ventures and subcontracts, manage the care and financial risks across the pathway. This will require NHS providers to enter into new types of risk-sharing contracts. Some academic health science centres are already developing plans to create broader partnerships that will evolve into integrated delivery systems. Commissioning needs to move away from commissioning institutions to commissioning services and care, specifying the outcomes to be achieved not how the service should be provided. 

There is a danger that providers misunderstand the implications of competition law for the NHS and therefore resist the idea of forming partnerships or integrating services. In the private sector, providers have long-term relationships with suppliers, enter into joint ventures and form consortia to bid for contracts. NHS providers may need to break up their current configuration of services – for example, creating franchises of specialist services in local hospitals which are owned and run by other trusts.

The coalition government’s reforms have implications for providers, but  the most immediate disruption will be felt by commissioners. Providers must not wait around until the commissioning intentions of GP consortia are clear. They need to be proactive, working with others in the voluntary and private sectors to design high-value services which no commissioner could refuse to buy.

http://www.kingsfund.org.uk/blog/qipp_commissioning.html

The Bill passed with a vote and will now be considered in a Public Bill Committee. Watch and read the views expressed by MPs who took part in the debate. A list of those MPs that voted can be found at the end of the debate in Commons Hansard.

• Watch the debate: Second reading of Health and Social Care Bill
• Commons Hansard: Health and Social Care Bill, second reading
• Commons Hansard: Voting list of MPs

Have your say

The Bill has now been sent to a Public Bill Committee for scrutiny and there is a call for written evidence.

Do you have relevant expertise and experience or a special interest in the Health and Social Care Bill?

If so, you can submit your views in writing to the House of Commons Public Bill Committee which is going to consider this Bill.

Guidance for submitting written evidence

• How to submit written evidence to the Public Bill Committee

Deadline for submissions

The Committee is able to receive written evidence from Monday 31 January, when the Bill passes the Second Reading Stage; and will stop receiving written evidence at the end of the Committee stage on Thursday 31 March. The sooner you send in your submission, the more time the Committee will have to take it into consideration. The Public Bill Committee is expected to meet for the first time on Tuesday 8 February.

Summary of the Bill

The Bill proposes to create an independent NHS Board, promote patient choice, and to reduce NHS administration costs.

Key areas

Measures in the Bill would give consortia of General Practitioners responsibility for commissioning the majority of health services, and create an independent NHS Commissioning Board.

It would abolish Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs) and transfer local health improvement functions from PCTs to local authorities. It would also give local authorities responsibilities for coordinating the commissioning of local NHS services, social care and health improvement.

The Bill would introduce measures to promote competition between providers of NHS-funded services and would provide for all remaining NHS trusts to become foundation trusts.

Other parts of the Bill deal with the functions of several ‘arm’s length bodies’, and the regulation of health and social care workers. There are also a number of consequential amendments and miscellaneous provisions.

Keep up to date with all the proceedings on the Health and Social Care Bill and find out how a Bill becomes an Act of Parliament.

• Bills before Parliament 2010-11: Health and Social Care Bill
• About Parliament: Passage of a Bill

House of Commons Library analysis

The House of Commons Library regularly produce briefing papers which inform MPs about key issues. The Library has produced a Research Paper on the Health and Social Care Bill.

• Commons Library research paper: Health and Social Care Bill 
• Topics: Health services

Health Select Committee Report

The Commons Health Select Committee recently published its report into the commissioning of health care in the NHS. The Government has responded to the report.

• Health Committee Report: Commissioning
• Government response to the Health Committee Report: Commissioning (PDF 299KB)

Second reading

Second reading is the first opportunity for MPs to debate the main principles of the Bill. It usually takes place no sooner than two weekends after first reading.

What happens at second reading?

The Government minister, spokesperson or MP responsible for the Bill opens the second reading debate. The official Opposition spokesperson responds with their views on the Bill.

The debate continues with other Opposition parties and backbench MPs giving their opinions.

At the end of the debate, the Commons decides whether the Bill should be given its second reading by voting, meaning it can proceed to the next stage.

What happens after second reading?

The Bill proceeds to committee stage and will be considered in a Public Bill Committee. Each clause (part) and any amendments (proposals for change) to the Bill may be debated.

http://www.parliament.uk/business/news/2011/january/health-and-social-ca...

MPs examine the impact of Health and Social Care Bill on localism agenda

• Communities and Local Government Committee
• Watch the Meeting: Localism
• Bills before Parliament: Localism Bill

Witnesses

14 February, Grimond Room, Portcullis House:

4.20 pm

• Mr Paul Burstow MP, Minister of State for Care Services
• Mr Andrew Larter, Deputy Director for Local Government and Regional Policy, Department of Health;

4.45 pm

• Rt Hon Greg Clark MP, Minister of State for Decentralisation, Department for Communities and Local Government

http://www.parliament.uk/business/committees/committees-a-z/commons-sele...

The Prime Minister has said that the government will not now scrap the mobility allowance for people in care homes. According to the Health and Social Care Bill, the plan was to save around £230m by removing the payments.

The revelation came during Prime Minister's Questions when the Labour leader Ed Miliband asked why the allowance was being stopped. David Cameron said that it wasn't and sat down immediately. When challenged by Miliband as to whether there had been a change of heart, Cameron said that the idea was under review and suggested the government had listened to the views of people who were opposed to it. Miliband pointed out that if it is in the Bill it is a policy, not an idea for review.

The exchange went as follows. Miliband said: "Will the Prime Minister explain why he proposes to remove the mobility component of disability living allowance from 80,000 care home residents?"

Cameron retorted: "The short answer is that we are not."

In an exasperated tone, Miliband said: "Not for the first time, I have to tell the Prime Minister what is in his own legislation: clause 83 of the Welfare Reform Bill proposes precisely that and people do not understand why he is doing it. If he is saying that he is going to abandon the policy, then, great, let us abandon the policy."

The PM replied: "The review of disability living allowance and the mobility component is wrapped up in the new personal independence payment. That is what is happening. To be frank, this point has been raised right across the House of Commons and is a point that we have responded to. It is a review that the right honourable gentleman can take part in; perhaps he can say something constructive."

Miliband said: "It is not a review, it is a proposal – a clause – in the Bill to take away the mobility component of DLA. Some 22 disabled persons organisations up and down the country are saying that the government should abandon the policy. I have a suggestion for the Prime Minister: why does he not complete the review now and say that he is dumping the policy? He has done it before."

Cameron ended the exchange by saying: "The first thing the right honourable gentleman said about disability living allowance was that he wanted to support our gateway reforms, but we do not hear much about that any more. As I have said, the review of DLA is rolled into the personal independence payment. That is how we will reform the mobility component. Instead of getting so excited about it, he should congratulate the government on listening to opinion from across the House."

http://www.publicservice.co.uk/news_story.asp?id=15880

Health Secretary Andrew Lansley has today announced a fourth group of GPs ready to lead the way and modernise the NHS.

220 groups of GP practices across the country covering nearly 90% of the population have come forward so they can directly commission bespoke services focused on delivering the best outcomes for their patients. This means that 45.7 million people around the country will now receive personalised care from the clinician that knows them best.

The selected pathfinders represent GPs who have demonstrated readiness to start taking on commissioning responsibilities.  The groups will work together to help manage local budgets and purchase services for patients directly with other NHS colleagues and local authorities.

Health Secretary Andrew Lansley said:

"Today we can announce that 90% of the country is now covered by groups of GPs who are best placed to deliver better care for patients. This uptake from the grass-roots is very encouraging and means that 9 out of 10 people in England will start to see the benefit of more personalised care.

"We welcome the new groups, which take the total number of GP pathfinders to 220. It is not only great news for patients but the entire NHS as doctors step forward to modernise services.

"Today is also the start of the new financial year and with it comes the delivery of our promise to protect the NHS with £11.5 billion of extra funding over four years."

Where emerging consortia have been formed, patients are already benefiting from local commissioning and healthcare services tailored to their needs.

In Barnet, for example, the NHS has worked together to set up a very successful local gynaecology service which is currently seeing 400 patients every month in a community setting.  It has high levels of patient satisfaction, has led to a reduction in hospital visits and reduced costs. 
 
In City & Hackney, GPs and hospital consultants at Homerton University Hospital have worked together to reduce new Outpatient Department referrals by 2.5% over the last year.

From the first, second and third wave of pathfinders, there are a number of further examples of innovative local commissioning:

• Barking & Dagenham Quality Care Consortium identified ophthalmology as an area where they could redesign services for the benefit of patients and bring care closer to home. Working together with consultants from their local acute trust and the primary care trust, they have developed a community based ophthalmology service which is expected to start later in the spring. This will allow GPs and optometrists to refer patients directly to the new service, reducing patient waiting times and avoidable hospital referrals.
• 
  In Bexley, GPs have put in place a new service which cuts the waiting time to obtain a diagnosis for coronary heart disease from up to nine months to as little as three weeks. The service uses a clinic in Harley Street to provide cutting edge scans, which are cheaper and safer than alternative diagnostic treatments.
• 
  In Nottinghamshire, GPs have improved care for the 4,000 diabetics in their region. By providing specialist support in local clinics in GP practices, the service avoids diabetics having to be treated in hospital.
• 
  In Redbridge, GPs send patients with skin problems to a local GP who specialises in them, meaning that patients can go to a local surgery, instead of having to travel further afield.
• 
  In Reading, GPs have organised a new service for people with back pain where physios go and treat patients in their own home.
• 
  In Somerset, GPs have organised oxygen therapy for people with breathing difficulties in their own homes which helps keep patients healthy and out of hospital.
• 
  In Croydon, GPs have organised diagnostic services – such as ultrasound – in their local GP practices. This means that patients are seen quicker, nearer to their homes, and can avoid travelling to hospital.
• 
  In Richmond, GPs have identified a need for more responsive community services to avoid unnecessary acute admissions. Working together with their local community services provider they are providing intensive support to patients in their own homes and have jointly designed a rapid response community team to get back to patients within two hours of contact.

GP pathfinders will be supported by the National Clinical Commissioning Network, the National Leadership Council, and by national primary care bodies, such as the Royal College of GPs’ Centre for Commissioning.

Notes to editors

1. The Health and Social Care Bill can be found at:  http://www.dh.gov.uk/en/Publicationsandstatistics/Legislation/Actsandbills/HealthandSocialCareBill2011/index.htm

2. A full list of the GP Consortia Pathfinders are attached to the press notice and can be found on the Modernisation Channel at:
http://healthandcare.dh.gov.uk/about/

3. For further media enquiries please call the Department of Health Newsdesk on 020 7210 5221.

DETAILS OF FOURTH COHORT OF PATHFINDERS

East of England: Bedfordshire Clinical Commissioning Consortium
(1 Consortia, population coverage 429,000)

East Midlands: The Nottingham North & East (NNEC), Lincolnshire South West, Boston, Highpoint, Leicester City GP Consortium
(5 pathfinders, population coverage 2,199,110)

London: NHS Islington GP Commissioning Consortium, Haringey GP Consortium. Barnet GP Commissioning Consortium, Enfield Consortium Group, City & Hackney ELIC, Tower Hamlets GP Consortium, KLEAR Healthcare Consortium, Bromley, Lewisham Primary Care Federation, Hammersmith & Fulham GP Commissioning Consortium, Commissioning for Croydon, Harrow GP Commissioning Consortium
(12 pathfinders, population coverage 2,936,763)

North East:  Middlesbrough, Greater Easton, Hartlepool Commissioning Group, CareFirst (North Tyneside) 
(4 pathfinders, population coverage 455,156)

North West: GP CARE Group CIC (Community Interest Company), Greater Preston, Tameside & Glossop, Liverpool GP Commissioning Consortia, Runcorn Commissioning Consortium & Widens Commissioning Consortium,
Pendle, Knowsley South Health Consortium
(7 pathfinders consisting of 8 consortia, population coverage 1,291,124)

South Central: Southampton City GP Commissioning Consortium, Portsmouth City GP Commissioning Consortium, Premier MK
(3 pathfinders, population coverage 632,464)

South East Coast: Salveo (South West Kent), Sasse (North West Surrey)
(2 pathfinders, population coverage 463,000)

West Midlands: Forward Health Consortium, Equity Healthcare Consortium, Birmingham Inner City Consortium, Godiva Consortium, In Spires GP Commissioning Consortium, Shropshire Commissioning Consortium  (6 pathfinders, population coverage 1,048,497)
 
Yorkshire and Humber: Ryedale, Scarborough, Greater York
(3 pathfinders, population coverage 441,500)

http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_125775

Thankfully, we don’t have to imagine. The work of the NHS Sustainable Development Unit (SDU) has given us a good measure of the size and nature of the environmental footprint of the NHS.  The bottom line is that Europe’s biggest employer is also Europe’s biggest public sector polluter, accounting for one quarter of all public sector carbon emissions in the UK - and this is before we add emissions related to other providers of health and social care.

So why should we care? There are several good reasons – legal, financial and ethical – why everyone working in health and social care should take environmental sustainability seriously. Government policy will make it increasingly difficult (and expensive) to ignore sustainability, and the health and social care sector is coming under growing pressure to reduce its environmental impact. The government’s ‘Carbon Reduction Commitment', launched in 2010, and other policy levers still in development such as carbon budgets, mean that poor environmental performance will have new costs attached. These costs will increase substantially as carbon prices rise.

Rather than waiting for government policy to force their hand, forward-thinking organisations are already seeing the opportunities that sustainability presents. Other business sectors have found that a focus on sustainability can act as a powerful driver for innovation and improved efficiency. Cost-benefit analyses indicate that many carbon-reducing interventions in health care, such as reducing drug wastage or installing combined heat and power units in hospitals, could deliver significant net savings to the NHS.

Ultimately, it is also in patients’ interests that we pay attention to sustainability. The 2010 annual report by the Department of Health’s Chief Medical Officer highlighted ’substantial and fortuitous overlaps’ between sustainability and good quality care. For example, transforming care pathways or delivering care closer to patients’ homes can reduce emissions while also improving the care received by patients.

However, there is much that remains unknown about how we can develop more sustainable health and social care. Over the next year The King’s Fund will be conducting a scoping review to establish the priorities for future research in this area, with funding from the National Institute for Health Research and the Social Care Institute for Excellence. By clarifying the research needs, we hope to create a framework to co-ordinate future research on sustainability in health and social care. This will build on the ‘route map for sustainable health ’ recently published by the SDU.

Over the next decade, environmental sustainability seems set to become an increasingly prominent concern within health and social care, as in other sectors. The long-term challenge goes well beyond changing light bulbs in hospitals – it will require a transformational change in terms of the kind of care we provide, and the way in which it is delivered. It is therefore an agenda for everyone working in the sector. Only by accepting a shared responsibility will we be able to develop a sustainable health and social care system that meets the needs of the future.

http://www.kingsfund.org.uk/blog/sustainable_health.html

They believe it is vital to make these changes to enable the NHS to meet the unprecedented challenge it faces of finding 4% annual efficiency savings over the next four years.

• Report: Commissioning: Further Issues
• Health Committee

In their latest review of NHS Commissioning, MPs on the cross-party Commons Health Committee recommend a number of significant changes to the Health and Social Care Bill, currently before Parliament.

The Committee's Chairman, former Health Secretary Stephen Dorrell MP, says:

"We believe it is crucial to get the reform of NHS commissioning right if the service is to confront the massive financial challenge it now faces. Our report contains a set of practical proposals to strengthen the Health and Social Care Bill and make it better able to meet the Government’s objectives.

Our proposals are designed to ensure that NHS Commissioning involves all stakeholders – GPs, certainly, but also nurses, hospital doctors, and representatives of social care and local communities. We believe this broadening of the base for commissioning is vital if we are to achieve the changes that are necessary to allow the NHS deliver properly coordinated healthcare".

The most significant proposals include:

Local Commissioning Boards

Local NHS commissioners are statutory bodies responsible for a large proportion of public expenditure; they should be required to comply with the highest standards of governance and accountability.

In order to satisfy this standard each commissioner should be required to establish a Board where GPs should form a majority of membership but other places should be reserved for:

• A professional Social Care representative
• An elected member (a councillor or directly-elected Mayor), nominated by the local authority
• A nursing representative
• A representative of hospital medicine
• A public health expert nominated by the Director of Public Health

Scrutiny and the patient's voice

The Committee believes that local authority scrutiny of health services should continue and welcomes the extension of local authorities' health scrutiny powers.

MPs recommend that NHS commissioners should be given a legal obligation to consult Healthwatch, and that Healthwatch should have a legal obligation to consult with patients and patient representative bodies.

Accountable executives

The Committee recommends that all NHS commissioners should have a Chief Executive and a Finance Director, both of whom should be members of the Board.

Independent Chair

The Committee recommends that all NHS Commissioners should have an independent chair, appointed by the NHS National Commissioning Board.

Meetings and Papers

The Committee recommends that the Boards of NHS Commissioners should be required to meet in public, publish their papers and comply with the rules of the Committee on Standards in Public Life with regard to conflicts of interest amongst board members.

Accountability to the NHS Commissioning Board

The Committee recommends that NHS Commissioners should be held to account by the new NHS National Commissioning Board through a clear system of authorization and assurance.

A new name

The Committee concludes that the Government's plan to call local commissioning bodies "GP Consortia" is misleading. It proposes that these bodies should be referred to as "NHS Commissioning Authorities".

Health and Wellbeing Boards

The Committee believes that its own proposals would mean that there is no need to proceed with the establishment of Health and Wellbeing Boards.

Commissioning of Primary Care

The Committee also believes that its proposals would mean that there is no need to separate the commissioning of primary and secondary care – as currently proposed in the bill. The Committee proposes that NHS Commissioning Authorities should be responsible for commissioning primary, secondary and community healthcare, as well as for creating robust links with social care.

Commenting further Stephen Dorrell says:

"Ever since 1948 the NHS has suffered from an artificial distinction between primary and secondary care. Instead of entrenching this distinction further, this is an opportunity to abolish it for good – and create a single, integrated health service which is able to provide properly coordinated health and social care to all patients.

It is an opportunity to deliver greater efficiency and high quality at the same time. It is a 'win-win'; what is the argument against?"

http://www.parliament.uk/business/committees/committees-a-z/commons-sele...