Home Liberating the NHS
Secretary of State for Health Andrew Lansley set out the Government's ambitious plans to reform the NHS during this Parliament and for the long-term on 12th July 2010. The White Paper ‘Equity and Excellence: Liberating the NHS' 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.
A PSNC summary of the White Paper has been prepared for LPCs and pharmacy contractors.
Comment on the White Paper
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.'
PSNC Chief Executive Sue Sharpe said:
"We are confident that the White Paper makes provision for the continued development of high quality community pharmacy services. We especially welcome its recognition of an "important and expanding role" for pharmacy; both in helping patients make better use of medicines and in supporting better health.
"We are pleased that pharmacy will retain a national framework, and that commissioning of pharmacy services will be the responsibility of the new NHS commissioning board. The development of community pharmacy services has for too long been held back by the vagaries of patchy PCT commissioning, and this process of reform represents an opportunity to find a better, more cohesive way of ensuring all communities can benefit from high quality pharmacy services. The decision to give Local Authorities control over the commissioning of public health services is also good news for pharmacy; pharmacies are well-placed to build links with local councils, and are ideally positioned to help them cost effectively improve the health and well-being of the communities they serve.
"There can be no doubt that this White Paper represents a seismic change in the structure and culture of the NHS. We recognise that the process of restructuring our health service will not happen overnight, and look forward to working with the Government to ensure that pharmacy's full potential is harnessed in realising the White Paper's vision".
Read Sue Sharpe's analysis of the implications of the White Paper for Chemist + Druggist
Resources and links
A PSNC summary of the White Paper has been prepared for LPCs and pharmacy contractors.
The White Paper can be downloaded in full, alongside supporting documents at www.dh.gov.uk/liberatingthenhs.
Supporting document and consultations on the White Paper
The Department of Health plan to issue a number of policy documents providing more detail on the proposals in the White Paper over the coming weeks; some of these documents will take the form of formal consultations. When these documents are published a link to them will be added below. Where appropriate, PSNC will respond to consultations in due course; a copy of the PSNC response will be availalbe on this website.
1) Transparency in outcomes - a framework for the NHS (19th July 2010)
This 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; and
-
Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm.
2) Liberating the NHS: Increasing democratic legitimacy in health (22nd July 2010)
This consultation builds on the proposals in the White Paper to increase local democratic legitimacy in health. This will be achieved through local authorities: i) being given a stronger role in supporting patient choice and ensuring effective local voice ii) taking on local public health improvement functions, and iii) promoting more effective NHS, social care and public health commissioning arrangements.
This document links closely to the consultation on commissioning for patients. Taken together, these two documents set out the strategy for commissioning of health, care and wellbeing. They set out how the new system will work together to provide improved outcomes for patients, users and the public.
3) Liberating the NHS: commissioning for patients - consultation on proposals (22nd July 2010)
The Government's White Paper set out proposals for putting local consortia of GP practices in charge of commissioning services to best meet the needs of local people, supported by an independent NHS Commissioning Board. This document provides more detail on proposed arrangements and seeks views on a on a number of areas including:
- How GP consortia and the NHS Commissioning Board can best involve patients in improving the quality of health services;
- How GP consortia can work closely with secondary care, community partners and other health and care professionals to design joined-up services that are responsive to patients and the public;
- How the NHS Commissioning Board and GP consortia can best work together to make effective and efficient commissioning decisions; and
- How the NHS Commissioning Board can best support consortia and ensure they achieve improvements in outcomes within NHS resources.
4) Liberating the NHS: regulating healthcare providers (26th July 2010)
In the White Paper the Government set out that all NHS trusts will become foundation trusts by 2013. This consultation puts forward proposals to free up foundation trusts to innovate for improved outcomes and services by:
-
removing the statutory private income cap to give trusts opportunities to expand the services they offer to patients - but ensuring that they remain focussed on providing NHS services;
-
removing statutory borrowing limits that are not imposed on voluntary or private providers;
-
making it easier for a foundation trust to merge or take over another trust; and
-
giving more flexibility to foundation trusts to allow greater staff and patient involvement - with the possibility of some smaller organisations being led only by employees.
Monitor will become the economic regulator for the NHS, sitting alongside the Care Quality Commission (CQC) who will continue to regulate quality. It will be responsible for:
-
licensing providers of NHS services in an integrated and streamlined registration and licensing regime with the CQC;
-
setting tariff prices for NHS services;
-
promoting competition so that the NHS gives patients the best possible services and outcomes, and ensuring a level playing field for providers; and
-
supporting commissioners in ensuring that services for patients are maintained when providers fail.
5) Liberating the NHS: Report of the arms-length bodies review (26th July 2010)
Bureaucracy will be cut and the functions of several organisations will be streamlined, following a review of arm's length bodies (ALBs). In total, the changes outlined in this report will reduce the number of health ALBs from eighteen to between eight and ten; they are expected to deliver savings of over £180m by 2014/15. In line with the wider reforms set out in the White Paper the Department of Health's ALB sector will be transformed to cut cost and remove duplication and burdens on the NHS.
The review has assessed whether the work of each of the Department of Health's 18 Arm's Length Bodies' remains essential nationally. It also looked at whether work is being duplicated or could be better carried out by a different body. Subject to Parliamentary approval, organisations which are no longer needed will be removed from the sector, with essential work moved to other bodies. This process will increase the ability of the organisations to do their important work in the most efficient way. It is also part of the cross-Government strategy to increase accountability and transparency, and to reduce the number and cost of quangos.
Frequently Asked Questions
The following answers to the FAQs are based on the knowledge availalbe at this time; the situation may change as more detail on the White Paper proposals is published by DH.
1) Will the White Paper affect national contract negotiations?
PSNC is pleased that community pharmacy will retain a national contract, and that the national commissioning of pharmacy services will be the responsibility of the new NHS Commissioning Board. The development of community pharmacy services has for too long been held back by the vagaries of patchy PCT commissioning, and this process of reform represents an opportunity to find a better, more cohesive way of ensuring all communities can benefit from high quality pharmacy services. We look forward to working with the government to effectively harness pharmacy's potential on a national scale. Prior to the establishment of the NHS Commissioning Board, PSNC will continue its work with DH and NHS Employers.
2) Will GP consortia commission pharmacy services?
There may well be a role for GP consortia in commissioning some pharmacy services, particularly those focussed on the management of long-term condition. GP consortia are likely to focus much of their efforts on the commissioning of secondary care services. It is worth noting, however, that a large proportion of locally commissioned pharmacy services fall under the category of public health; an area that the White Paper indicates will become the responsibility of Local Authorities. Community pharmacies are well-placed to build links with local councils, and are ideally positioned to help them cost effectively improve the health and well-being of the communities they serve.
3) How the new commissioning arrangements will affect the structure of LPCs?
It is important that local representative bodies such as LPCs are structured in a way that best reflects the local NHS landscape. It may be some time before details are determined as to how the local representative committees for the contractor professions will fit within the new NHS structures, e.g. the regional offices of the NHS Commissioning Board. As the restructuring set out by the White Paper progresses, we will support LPCs in ensuring that local representation serves the needs of community pharmacy in the most effective way possible.
4) Which organisations will LPCs need to work with in the future?
LPCs will probably need to develop relationships with GP consortia, local authorities and the regional offices of the NHS Commissioning Board.
5) What will happen to Pharmaceutical Needs Assessments (PNAs)?
We expect that PCTs will continue to develop PNAs over the coming months. It is not clear which organisations will manage PNAs after PCTs are abolished, but it may be a role for the regional offices of the NHS Commissioning Board or local authorities.