What the Government heard about the NHS

In April, the Government “paused” their Health and Social Care Bill. The reason? The public didn’t seem to like it much, nor did many health professionals.  A number of charities, including Age UK, welcomed many of underlying principles but had deep reservations about how some aspects of the reforms, such as public involvement and accountability, had been expressed in legislation.

Ten weeks later, the Government has concluded its listening exercise. Earlier this week, the NHS Future Forum, a panel of experts and senior clinicians co-piloting the listening exercise, published their recommendations. The Government has now responded, setting out how it now intends to take the Bill forward, taking on board many of the NHS Future Forum’s recommendations.

Age UK had five key things we want to see the NHS doing after the proposed reforms:

  • Delivering better outcomes for older people
  • Better public and patient engagement
  • Ensuring accountability
  • Stronger Health and Wellbeing Boards
  • Promoting integration between services

Age UK has been working with a number of health charities to see these aspirations reflected in the Bill. Following the Government’s announcement this week, we are more confident that we enter the next stages of the Bill with these aspirations at the heart of the reform programme. So what has changed?

One of the highlights is that GP commissioning consortia, the bodies that would have been the local purchaser and planner of local health services, will now be called clinical commissioning groups. These groups will need to involve a much wider range of health professionals and, importantly, there will be a requirement for the boards of these groups to include two lay members –  i.e. non-clinical representatives of the public. There will also be far clearer requirements for transparency such as the need to hold meetings in public and publish all their papers.

We expect this to signal a much more robust commitment to patient and public involvement within the NHS. What this, and other aspects of the changes, indicate is that the Government is taking involvement seriously and recognising the benefits it brings. In talking about improving outcomes, it is rarely possible to define and work towards high quality outcomes without talking to the people experiencing the care. Having a range of different health professionals involved in the board will also be good news for the many older people who themselves work with a range professionals to manage their health.

This should be one of the take away messages of these latest changes to the Government’s reforms – ‘no decision about me without me’ is now a step closer to becoming the reality for patients on the ground.

Health and Wellbeing Boards will have greater powers to ensure health and social care services work together. It was always part of their role to produce a local health and wellbeing strategy which the commissioning consortia would then reflect within their plans.  But Government now says Boards will have more scope to hold commissioners to account if they don’t. Health and Wellbeing Boards will also have a say in the size and geographical shape of the clinical commissioning groups, where there is now clearer expectations that commissioning consortia will match up with local authority boundaries.

Many people had been concerned about the role of Monitor, which had been tasked with promoting competition. The Government now says that it expects Monitor to be responsible for promoting integration. In practice, this should mean that Monitor will seek to ensure local services work well together. Competition will still be part of their role, but they will only act on this where there is a public interest.

Other highlights include protection against “cherry-picking” – the idea that private providers would be able to select only “non-complex” people to treat; the removal of many deadlines such as that for clinical commissioning groups to be ready by April 2013; and the introduction of “clinical senates” which will provide guidance at a regional level.

In practice, there are some changes here that are not, in fact, very big and others which could be significant. Monitor will have some substantial elements of its role taken away, but it was always the case that public interest would trump competition (though it is a useful presentational change). The role of the Health and Wellbeing Board is entirely in line with the original vision, they’ve simply set out to make its role as a driver of change more explicit and with a few extra teeth.

This is not the end of the process for ensuring these reforms work for older people and Age UK will continue to scrutinise the Government’s plans. There is clearly a long way to go before these principles start making the kind of difference they need to make. However, these latest announcements are a further step in the right direction.

Author: Tom Gentry

Policy adviser - health services @tomogentry

One thought on “What the Government heard about the NHS”

  1. Leaving aside the shameful political horse trading that has led to the current position, I am not hopeful that these changes are in any way transformational. One of the problems with the NHS is its terrible introspection and the self-serving behaviour of all of the factions involved. The role of politicans is another matter.
    I consider myself reasonably well informed and literate but all I see shaping up is a great deal of upheaval, a merry-go-round of the same old faces changing roles, a continuance of the endemic ‘my interests first’ culture of the public sector, thus little real change.
    My experience of the NHS over a lifetime (during which it has saved my life on several occasions) is that acute care works and so does the private sector. Both of these sectors work because they are focussed upon the needs of the customer. Step outside of these areas and you are invariably treated as a third party to your ailment, with little respect and an impediment to the smooth running of the ingrained and PC mentality.
    The NHS is overloaded and cannot continue in its current state; simply because it is free at the point of consumption leads to wasteful calls being made upon its services. The cost of modern medicine is also growing and will continue to do so.
    There is a knee-jerk reaction from all sectors if the private sector is mentioned in the same breath as medicine (invariably irrationally). If a respected high street brand such as Marks and Spencer or John Lewis announced it had won a contract to provide certain areas of care, there would be public acceptance and the customer could rest assured their needs were being met (and respectfully).
    However, notwithstanding all of the above, I feel that Age Concern has a way to go to identify with and connect with the interest group it purports to represent. Please do not consider me disrespectful if I point out that your blog owes more to the newspeak of an ingroup than a serious and informed attempt to speak to older people.

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