Experts demand changes to NHS plans
Monday 13 June 2011
The Government's plans for the NHS must undergo significant changes to secure the future of the health service, experts said today.
The aim of improving services is universally supported but there are "genuine and deep-seated concerns" which need to be addressed, the NHS Future Forum, appointed by the Government to review its plans, said.
The Health and Social Care Bill is currently on hold on its passage through Parliament after Prime Minister David Cameron announced a "pause" for reflection.
The Bill has attracted criticism from the medical profession and unions, particularly over increasing competition between the NHS and private companies.
Over the last two months, members of the forum have met more than 6,700 people face to face and have received more than 29,000 emails, comments and questionnaires.
The Government will officially respond to the report tomorrow, but Prime Minister David Cameron has already outlined "real changes" to the reforms - pre-empting the content of the report.
Key recommendations include:
:: Altering the role for NHS regulator, Monitor. The Bill originally said Monitor's primary duty should be to promote competition. This must now be "significantly diluted" and amended to require Monitor to support choice, collaboration and integration. Monitor should be seen as a sector regulator for health, not an "economic regulator".
:: Private firms should not be allowed to "cherry pick" patients and "the Government should not seek to increase the role of the private sector as an end in itself". The concept of any qualified provider in healthcare will remain, although companies will not be able to compete on price.
:: The Health Secretary must be ultimately accountable for the health service. The Bill should be amended to make sure this responsibility stays in place.
:: Increased transparency about how the NHS runs, including the decisions made by GP consortia, who will take control of £60 billion of the NHS budget.
:: GP consortia must take advice from different professionals, including hospital doctors. Clinical senates of NHS staff from different specialties should be established to provide "strategic advice".
:: The deadline of 2013 for consortia to take on responsibility for commissioning should be scrapped in favour of a more fluid timescale.
Publishing the findings, NHS Future Forum chairman Professor Steve Field said the NHS would be in a "strong position" to tackle future challenges, including an ageing population, if the Government accepted its recommendations.
"There is no doubt that the NHS needs to change," he said.
"The principles underlying the Bill - devolving control to clinicians, giving patients real choices and control, and focusing on outcomes - are well supported.
"However, during our listening we heard genuine and deep-seated concerns from NHS staff, patients and the public which must be addressed if the reforms are to be progressed.
"If the substantial changes we propose are accepted by Government, then I think the resulting framework will place the NHS in a strong position to meet this objective and tackle the pressing challenges in the years ahead."
The report calls for patients to be at the heart of reform and says they want choice over care and treatment which extends beyond which hospital they attend.
The new NHS Commissioning Board should therefore be given a "choice mandate" while a new citizens panel should report to Parliament on how well it has been implemented.
Further work should also be done to give citizens a new "Right to Challenge" poor-quality services and lack of choice.
A new duty should be put on the NHS Commissioning Board and GP consortia actively to promote the NHS Constitution, which sets out patient rights, including on waiting times.
And while it is important that competition is not used for the sake of it, it is "important to promote a diversity of providers".
Mr Cameron has agreed to curbs on cherry-picking, a bigger role for medics other than GPs, a slimmed-down role for Monitor and for the 2013 deadline to be scrapped.
Aides to the Prime Minister have insisted he was the driving force behind the policy rethink, but many Tory backbenchers are furious that Health Secretary Andrew Lansley has been "hung out to dry" to appease Lib Dems.
Deputy Prime Minister Nick Clegg will tell his party tonight he ensured their "voice was heard" and the new package is a "job well done".
Mr Lansley said: "The forum has been an invaluable source of expert advice and I have said we must keep listening on the NHS to deliver a world-class health service.
"The forum's reports show clear support for a health service that puts patients at the heart of everything it does, and where services are joined up, accountable and focus on delivering better results for patients.
"The forum's approach is one on which we can build a strong NHS for the future."
Dr Hamish Meldrum, chairman of the British Medical Association (BMA), said the report had addressed many concerns but some still remained.
He added: "Obviously, the critical factor is now how the Government responds, as well as ensuring that the detail of the changes matches up to expectations.
"But if the Government does accept the recommendations we have heard today we will be seeing, at the least, a dramatically different Health and Social Care Bill and one that would get us on to a much better track."
Chris Ham, chief executive of the King's Fund, said the recommendations would "significantly improve" the Health and Social Care Bill but it was now time to move on with the reforms.
Dave Prentis, general secretary of Unison, said big questions over critical issues such as privatisation remained unanswered.
"The forum is recommending sweeping changes to the Bill because it is riddled with flaws.
"It exposes the real agenda behind the Government's Bill - the wholesale marketisation of the NHS.
"It wants to turn our health service into nothing more than a logo on the side of a van run by a multinational company."
Shadow health secretary John Healey said: "The Future Forum report is a demolition job on the Tory-led Government's misjudgements and mishandling of the NHS over the past year.
"The big test is for David Cameron and whether he will fundamentally rewrite his NHS legislation and give up the long-term Tory plan to turn the NHS into a full-scale market.
"We will judge the Prime Minister on what he does, not what he says."
He added: "What Professor Field recommends can largely be achieved without the Government's legislation and without David Cameron's high-risk and high-cost reorganisation."
The plans affect the NHS in England.
Katherine Murphy, chief executive of the Patients Association, said: "The Patients Association cautiously welcomes the results of the NHS Future Forum, which proposes significant changes to the Health and Social Care Bill.
"We welcome the commitment to the NHS Constitution. The NHS Constitution is the contract between the NHS and patients that patients refer to.
"It is vital in guaranteeing patients' rights and without it many patients would be left unsure about what they should expect from the NHS.
"The role of Monitor and the place of competition within the NHS have been controversial since the reform plan was announced last July.
"Many of the patients who talked to us in our independent listening events and via our survey were concerned that this move would spell the end of a public NHS and was back-door privatisation.
"We agree that the Department of Health must move away from this overtly market-driven model and put measures in place to prevent companies from cherry-picking services.
"The NHS needs to be about collaboration and not competition."
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