News
Government launches consultations on healthcare reforms in England:
outcomes, commissioning, democracy
22 July 2010
The government's detailed proposals for reform of the NHS in
England have been set out by the Department of Health in a series of
public consultations launched this week.
This follows the White Paper, Equity and Excellence: Liberating the
NHS, published on 12 July, that laid the framework for the
Government’s policies on reforming the NHS (see BJHC&IM news
Government
launches reform of NHS financing and structure).
There will be a series of visits and events that will take place
across the country this summer to present and discuss the reform plans.
The consultations close on 11 October 2010.
Chief Executive of the NHS Sir David Nicholson already sent out a
letter to NHS chief executives and chairs last week ordering the changes
laid out in the White Paper to be implemented as rapidly as possible.
He has appointed a Managing Director of Commissioning Development and
a national Managing Director of Provider Development to oversee the
separation of the provider and commissioning functions in primary care.
Similar positions are being created in each of the ten strategic health
authorities in England to achieve the split by the end of the year.
NHS organisations have to start moving resources from administration
to the front line to prepare for the "move from targets to outcomes". He
has also ordered consultations to take place throughout NHS
organisations, from board level down, to discuss the White Paper.
The publication, Transparency in Outcomes — a framework for the
NHS, launched this week, was the first in a series of specific
consultations seeking the views of healthcare professionals, the public
and other interested parties on the detailed proposals.
The publication proposes a new framework that aims to refocus the NHS
on the outcomes achieved for patients rather than the process targets of
the past "that had no clinical justification".
The framework includes a set of national outcome goals which patients
and the public can use to judge the overall performance of the NHS and
hold the Government to account for progress. The framework and the
national outcome goals will form a combined mechanism by which the
Secretary of State for Health can hold the new NHS Commissioning Board
to account for the outcomes it is securing for patients.
The consultation document suggests five outcome domains and seeks
views on the structure and the core principles that should underpin the
development of the framework, as well as the more specific outcome
measures that should be used. The proposed domains are:
- Domain 1: Preventing people from dying prematurely
- Domain 2: Enhancing the quality of life for people with
long-term conditions
- Domain 3: Helping people to recover from episodes of ill health
or following injury
- Domain 4: Ensuring people have a positive experience of care
- Domain 5: Treating and caring for people in a safe environment
and protecting them from avoidable harm
Liberating the NHS: commissioning for patients, launched
today, sets out:
- responsibilities: the scope of the services for which consortia
and the NHS Commissioning Board will be responsible, their
responsibilities as commissioners of these services, and the
relationship between the responsibilities of the NHS Commissioning
Board, GP consortia and individual GP practices;
- establishment of GP consortia;
- freedoms, controls and accountabilities of consortia;
- partnerships: how consortia and the NHS Commissioning Board will
work with patients and the public, local government and health and
care professionals;
- implementation and next steps.
Liberating the NHS: Increasing democratic legitimacy in health,
also launched today, describes the enhanced role of local authorities
and the public. Local authorities will have an increased role in
healthcare in four areas:
- leading joint strategic needs assessments (JSNA)1 to ensure
coherent and co-ordinated commissioning strategies;
- supporting local voice, and the exercise of patient choice;
- promoting joined up commissioning of local NHS services, social
care and health improvement; and
- leading on local health improvement and prevention activity.
Public and patient involvement will be strengthened by transforming
Local Involvement Networks (LINks) into the more powerful HealthWatch,
which will act as local consumer champions across health and care,
including as an NHS complaints advisory service and supporting
individuals to exercise choice.
Local authorities will promote integration and partnership in health
and well being through Health and Well being boards. These will have
four main functions:
- to assess the needs of the local population and lead the
statutory joint strategic needs assessment;
- to promote integration and partnership across areas, including
through promoting joined up commissioning plans across the NHS,
social care and public health;
- to support joint commissioning and pooled budget arrangements,
where all parties agree this makes sense; and
- to undertake a scrutiny role in relation to major service
redesign.
Health Secretary Andrew Lansley said: "The White Paper set out the
Government's vision for the NHS — a quality service that achieves health
outcomes that are among the best in the world. I want to free doctors
and nurses to focus on what really matters — better results for their
patients — instead of them being stifled by top down targets.
“Instead of politically motivated targets which lack clinical
evidence, we will measure the outcomes that are most important to
patients and that are relevant to healthcare professionals. These will
be backed up by authoritative, evidence-based quality standards that
will ensure everyone understands how those outcomes can be achieved.
“I want to hear the views of healthcare professionals, patients,
carers and the public on how the new system should work, and what we
should measure to ensure the NHS is focussed on what is important to
patients and what improves their overall experience of NHS care."
Communities Secretary Eric Pickles said: “A decade of centralising,
controlling government has left public services like the NHS strangled
with red tape, lumbered with target after target, and weakened by the
need to report to bureaucrats instead of the public.
“Under proposals published today, for the first time in forty years
there will be local democratic accountability and legitimacy in the NHS.
“Elected councils will have a key role including commissioning
HealthWatch’ services to guarantee patients a voice. As we push power
away from Whitehall we will make the health service more answerable to
patients not politicians.”
Within a ring-fenced public health budget, local health improvement
funds will be held by local authorities, and decisions about how this is
spent will take account of all the local issues that impact on people’s
wellbeing. Local Directors of Public Health will be crucial to this
process, and the national Public Health Service, when created, will
complement local decision making with evidence, research and evaluation.
More information
1. The White Paper, Equity and Excellence: Liberating the NHS,
and Analytical strategy; Equality impact assessment; Draft
structural reform plan:
Download documents from the Department of Health.
See also BJHC&IM news GGovernment
launches reform of NHS financing and structure.
2. Consultation: Transparency in Outcomes — a framework
for the NHS and the letter from Sir David Nicholson to NHS chief
executives can be downloaded from:
www.dh.gov.uk/en/Healthcare/LiberatingtheNHS/index.htm
3. Consultation: Liberating the NHS: commissioning for patients
www.dh.gov.uk/en/Consultations/Liveconsultations/DH_117587
4. Consultation: Liberating the NHS: Increasing democratic legitimacy in health
www.dh.gov.uk/en/Consultations/Liveconsultations/DH_117586
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