Cameron concedes that health reforms should be ripped up


Oliver Wright
Sunday 23 October 2011 02:57

David Cameron and Nick Clegg will today endorse wholesale changes to the Government's controversial health reforms, giving patients the "right to challenge" poor services for the first time and guaranteeing them a choice of doctors and treatments.

The men have signed up to "99 per cent" of the recommendations put forward yesterday by the NHS Future Forum after a two-month consultation into the proposed changes.

These include:

* Scrapping the timetable for GPs to take responsibility for commissioning care for their patients. Some commissioning boards will start in 2013 but others may be delayed.

* Forcing all hospitals – even those run by private companies – and commissioning bodies to hold their meetings in public and publish their minutes.

* Re-asserting the role of the Secretary of State as holding the ultimate political accountability for NHS, which was missing from the original bill.

* Giving an obligation for commissioning bodies to set up "clinical senates" to provide expert evidence on the decisions they make. But there will be no guaranteed place on commissioning bodies for nurses, hospital doctors or other healthcare professionals.

* No "cherry-picking" of easy cases by private companies working in the NHS. Private providers will also have to provide money for training doctors and nurses – even if they don't do it directly themselves.

* Scrapping plans to give the Department of Health direct control of public-health policy.

* A new citizens' panel to report to Parliament every year on how the new structures are working. Patients will also be given the "right to challenge" poor services, which could lead to new providers running badly run hospitals and heathcare services.

Unveiling their report, the Future Forum's five leaders called on politicians to put behind them the months of bickering over the health reforms.

"We believe the Government should accept our recommendations and amend the Bill appropriately," Professor Steve Field, the forum's chairman, said. "This is not an issue that's meant to be a political football.

"The time for political argument is coming to an end. We urge politicians to work together to take the NHS forward for the good of patients, for the public and for the staff of the NHS."

Professor Field also called for politicians to stop demonising NHS managers and warned that without good management the reforms were doomed to fail. "Managers have a critical role in the NHS," he said. "One of the most alarming things we found during this process was how demoralised they have become. The Government needs to do something very quickly to address this."

The 45 members of the forum met more than 6,700 people and received more than 29,000 emails, comments and questionnaires.

Professor Field said he expected most of their recommendations to be accepted. These will either form part of an entirely rewritten bill or be put forward as amendments. He did not rule out a future role for the forum in helping to implement or report back on how the reforms were working.

Reaction to the recommendations was mixed. Chris Ham, chief executive of the healthcare think-tank the King's Fund, said they would "significantly improve" the Health and Social Care Bill. "The Government must now move quickly to endorse the report, put an end to the disagreements that have dominated recent months and provide the direction and stability the NHS desperately needs to navigate the challenging times ahead," he said.

But Dr Hamish Meldrum, head of the British Medical Association (BMA), suggested there might have to be more negotiations.

"We are hopeful that our 'missing' concerns, such as the excessive power of the NHS Commissioning Board over consortia and the so called 'quality premium' will be addressed as more detail emerges. Obviously, the critical factor is now how the Government responds."

The 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."

How the plans have changed – and what it means for you

GP control

What did the original plan say? Initial proposals were for local GPs to form boards, or consortiums, which would command £80bn of the NHS budget and spend it on services. This was widely criticised for including too few medical professionals and omitting hospital doctors and nurses from the process.

Forum recommendations An additional layer of support to consortiums, "Clinical Senates", should be established to provide expert evidence for the decisions that they make. However, the consortiums themselves will still not have to include hospital doctors or nurses, as the forum said this would be "tokenism". They also recommended that the policy that consortiums must be up and running by 13 April 2013 should be scrapped. The report said: "Consortia should only take on their full range of responsibilities when they ... have the right skills to do so."

What will the Government do? Will accept the revised timetable but may yet concede to the "tokenism" of allowing outside representation on the boards to appease nurses and other health professionals.

Management and Bureaucracy

What did the original plan say? The 150 PCTs and 10 Strategic Health Authorities currently in control of services to be scrapped in favour of local GP consortiums and one national oversight body, the NHS commissioning board. The theory that middle management has long kyboshed NHS efficiency has been at the centre of the Government's reforms since there inception.

Forum recommendations The report attacked the Government's tendency to label NHS management as "empty bureaucracy", which it says has turned people off the idea of pursuing civil service careers in public health. Professor Steven Field, chairman of the Future Forum, said: "Managers still have a critical role to play and we need to act very quickly to make sure we don't lose them." The forum also wants a clause added to the bill requiring the health secretary to ensure there is a comprehensive health service to be retained.

What will the Government do? Will make warm noises towards managers, but in the long term they may struggle not to demonise them again. They have been easy political targets for years and it's hard to break old habits.

Competition and Regulation

What did the original plan say? Promoting competition would be a responsibility of the health economic watchdog Monitor, which would scrutinise the conduct of GP consortiums as well as opening service delivery to private competition.

Forum recommendations Monitor will no long have the responsibility to promote competition. "It was wrong," said Professor Field. "Monitor's role should be significantly diluted and the role for competition completely removed." The group also warned against involvement of the private sector "as an end in itself" and demanded the bill be changed to prevent private providers "cherry-picking" economically viable patients. However, it did not rule competition within the NHS – it just said it should be driven by patient choice and not ideology.

What will the Government do? Accept in full. But make no mistake competition in the NHS is there already and will stay.

Patient involvement

What did the original plan say? When the reform White Paper was published in January, Andrew Lansley pledged changes to the NHS would revolve around the maxim: "no decision about me, without me". However, the Health Secretary later conceded to a House of Commons select committee that an unclear presentation of how this would be achieved left patients worried they may be marginalised.

Forum recommendations Patients will be given the legal "right to challenge" poor services. There will also be a national Citizens Panel to report to Parliament every year on how the new structures are working. Local Health and Wellbeing boards which will include both patients and local authorities will be given more power to supervise GP consortiums. Professor Field reaffirmed the Government's promise to focus on patients, but added it must "become a reality, supported by clear duties of involvement written into the Bill".

What will the Government do? Accept in full. But meaningful patient involvement has never effectively worked in the NHS and this may not change – despite the warm words.

Public Health

What did the original plan say? As part of the Government's wider attempt to minimise sprawling bureaucracy, the Health Protection Agency, a semi-autonomous body tasked with public health management including emergency disease epidemics and virus outbreaks, would be scrapped and its role reincorporated into the Department of Health.

Forum recommendations The panel of five healthcare professionals presenting the report yesterday unanimously disagreed with Lansley's original proposal. They suggested that, rather than scrap the agency altogether, it be replaced by Public Health England, which would aim to enhance co-operation between all local authorities and health and social care bodies at a national level. "It needs an independent voice and we are encouraging the Government to set it up as an 'arms length' body or at least not incorporate it in to the Department of Health," said Fields.

What will the Government do? This may be a sticking point as it goes against the much heralded "bonfire of the quangos". They may kick it into the long grass. Oliver Wright and Oliver Duggan

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