My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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The NHS White Paper – Overall architecture of the reforms

Filed Under (Economic Regulator, GP Commissioning, Health Policy, Reform of the NHS, White Paper) by Paul on 12-07-2010

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Over the rest of this week I will be posting a number of entries to the blog covering different aspects of the reforms in the White Paper. Here, on the day it is published, I thought it would be useful to take the White Paper at face value and assume it is all implemented as the Government would want it to be.

There are therefore no critical comments in this blog, or doubts about the implementation. They will follow as I outline my ideas about each of these four themes of reform.

What will the overall architecture of the NHS look and feel like if this all happened?

The new architecture, as with the old, has four main themes

  1. What is the responsibility of the National in the English NHS?
  2. Who is commissioning health care and how are they doing it?
  3. Who is providing health care and how are they organised?
  4. What are the transactional relationships between commissioners and suppliers and how are they organised?

1          What is the responsibility of the National in the English NHS?

The money comes from national taxation and is collected from us all by the Treasury. They then give it to the Secretary of State who will develop a contract with the NHS Commissioning Board. This contract will contain a set of outcomes which the SoS will expect to be provided for the resource.

The Board will lead on the achievement of health outcomes, allocate and account for NHS resources. It will lead on quality improvement and promoting patients involvement and choice.

 The Board will be independent of Government with an independent chair and (hopefully) leading executives and non executives who understand how to commission health care. (Note most people who run the NHS at the moment have no experience of commissioning health care – they are mainly providers)

The Board will work to a new NHS Outcomes Framework which, after it has been consulted, will provide the direction for the NHS. The Board will be given clear financial controls and associated financial instructions that will be set by the Secretary of State in line with the Department’s continued Parliamentary accountability for expenditure and HM Treasury requirements

The Board will calculate practice level budgets an allocate these directly to GP consortia. (see 2 below)

The Board will be under a duty to establish a comprehensive system of GP consortia and there will be a reserve power for the NHS Commissioning Board to be able to assign practices to consortia if necessary 

Together with Monitor (see 3 below) the Board will ensure that commissioning decisions are fair and transparent and will promote competition.

The Board will be established in shadow form as a special health authority from April 2011. It will go live in April 2012

The Department of Health will be responsible for the Public Health Service with a ring fenced budget that will commission local government as the local arm of public health to carry out work to improve outcomes. 

2          Who is commissioning health care and how are they doing it?

The Department will shift decision making as close as possible to individual patients and will devolve responsibility for commissioning services to local consortia of GP practices. 

These consortia will be on a statutory basis with powers and duties set out in primary and secondary legislation. The consortia will include an accountable officer and the NHS Commissioning Board will be responsible for holding consortia to account for stewardship of NHS resources and for the outcomes they achieve as commissioners. In turn each consortium will hold its constituent practices to account against these objectives.

Every GP practice will be a member of a consortium as a corollary of holding a registered list of patients.

GP consortia will be responsible for managing the combined commissioning budgets of their member GP practices, and using these resources to improve the health care and health outcomes.

GP consortia will need to have sufficient freedoms to use resources in ways that achieve the best and most cost efficient outcomes for patients.

They will be in shadow form in 2011/12 taking on increased delegated responsibility from PCTs

They will take on full responsibility for commissioning in 2012/13

They will receive full allocations from the Board in late 2012 and take full responsibility from April 2013.

3          Who is providing health care and how are they organised?

The aim is to create ‘the largest and most vibrant social enterprise sector in the world’. Foundation Trusts will be freed from constraints so they can innovate to improve care for patients

All NHS trusts will become foundation trusts. Staff will have an opportunity to transform their organisations into employee-led social enterprises that they themselves control.

They will stop the private patient cap on income and will enable trusts to merge more easily.

Within 3 years all NHS trusts will become Foundation Trusts, and to ensure this happens the organisational model that comprises non NHS trusts will be abolished. A new Unit at the DH will drive progress.

Patients will be able to choose care from the provider that they think is best

Where the NHS trust is unsustainable the Secretary of State may apply the trust administration regime.

4          What are the transactional relationships between commissioners and suppliers and how are they organised?

From April 2013 Monitor will take on the responsibility of regulating all providers of NHS care, irrespective of their status.

From April 2012 Monitor will become an economic regulator with the responsibility for all providers of NHS care from April 2013.

Monitor will promote competition and will apply competition law to prevent anticompetitive behaviour. Monitor’s role will be to set efficient prices for NHS services. They will be required to consult with the NHS Commissioning Board.

(In another part of the White Paper the Department of Health is pledged to set prices for NHS services in a range of areas where at the moment they do not exist)

Monitor will also have a role in ensuring continued access to key services

They will have the power to intervene directly in the event of failure.

Providers will be governed by a stable, transparent and rules-based system of regulation. The Government’s aim is to free up provision of health care so that in most sectors any willing provider can provide services, giving patients greater choice and ensuring that effective competition stimulates innovation and improvements and increases productivity within a social market.

As it does now the CQC will act as quality inspectorate across health and social care for both publicly and privately funded care.

There is a much increased role for patient choice in driving improvements. In all cases the money will follow the choice of the patient and those institutions that fail to attract patients will fail. There is much talk of an information revolution which will drive patient choice in the same way that it does other goods and services.


One Response to “The NHS White Paper – Overall architecture of the reforms”

  1. All sounds very easy,having attended a lot of NHS Trust,SHA/PCT meetings over several years most of whats being discussed is a build up from the old PCGs and the redesign of hospital services,actually it is their mambers who make up the consortia.What will be harder to achieve/change is the culture that ignores all feedback that does not cheer lead things through.Some of the people currently in line for being given this new responsibility are past masters it should be interesting just how this will be monitored.The only avenue available for the community to raise concerns has been the local PCT where their concerns are minuted and for the most part actioned.I for one will be sorry to see them go.

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