The Government is committed to an NHS that is free at the
point of use and available to everyone based on need, not the ability to pay.
It wants to free NHS staff from political micromanagement, increase democratic
participation in the NHS and make the NHS more accountable to the patients that
it serves. That way it will drive up standards, support professional
responsibility, deliver better value for money and create a healthier nation.
The Government is increasing investment in the health service by £11.5 billion
over the next four years, and its modernisation plans will release £5 billion
of NHS bureaucracy savings that will be reinvested into patient care.
The NHS Future Forum confirmed that there is broad support for the principles
underpinning the reforms. It also confirmed that the NHS is in need of reform,
if we are to keep pace with the rising costs of treatments and technologies and
in anticipation of an ageing population. I would go further and say that
without change, the future of the NHS is under genuine threat. We need to find
a way to get a great deal more from less.
I’m pleased that the Government has listened to opinions of voters up and down
the country, and as a result, ministers have announced a number of key changes
to earlier proposals. These changes include:
Reaffirming that Ministers are accountable overall: the
Government make clear that the original duty to promote a comprehensive health
service will remain.
Wider involvement in clinical commissioning: GP consortia
will be called ‘clinical commissioning groups’ and will have governing bodies
with at least one nurse and one specialist doctor. Commissioners will be
supported by clinical networks (advising on single areas of care, such as
cancer) and new ‘clinical senates’ in each area of the country (providing
multi-professional advice on local commissioning plans) – both hosted within
the NHS Commissioning Board.
Stronger accountability: The Government shall ensure
improved governance for clinical commissioning groups by making sure that their
governing bodies will have lay members and will meet in public. Foundation
trusts will also have public board meetings. There will be a stronger role for
Health and Wellbeing Boards in local councils, with the right to refer back
local commissioning plans that are not in line with the health and wellbeing
strategy. The Government will also ensure that there are clearer duties across
the system to involve the public, patients and carers.
Safeguards on competition: The Government will ensure that
there are new safeguards against price competition, cherry picking and
privatisation. Monitor’s core duty will be to protect and promote the interests
of patients – not to promote competition as if it were an end in itself.
Support for integrated care: There will be stronger duties
on commissioners to promote (and Monitor to support) care that is integrated
around the needs of users – e.g. by extending personal health budgets and joint
health and social care budgets, in light of the current pilots. The NHS
Commissioning Board will promote innovative ways to integrate care for
A more phased transition: Commissioning groups will all be
established by April 2013 – there will be no two-tier system. But where a group
is not yet ready, the NHS Commissioning Board will commission on their behalf.
Monitor will continue to have transitional powers over all FTs until 2016 to
maintain high standards of governance during the transition. There will also be
A careful transition process on education and training, to avoid instability.
More details in the autumn; we’ll take the time to get it right.
Andrew Lansley has outlined the Key principles of the Bill:
That patients should always share in decisions about their
That front-line medical staff should lead the design of
That patients should have access to whichever services offer
the best quality.
That all NHS trusts should gain the freedoms of foundation
That we should take out day-to-day political interference
through establishment of a national NHS Commissioning Board and through strong
independent regulation for safety, quality and effectiveness.
That the public’s and patients’ voice must be strengthened.
That local government should be in the lead in public health
In June, the Prime Minister outlined five personal guarantees for the NHS:
We will not endanger universal coverage – we will make sure
it remains a National Health Service.
We will not break up or hinder efficient and integrated care
– we will improve it.
We will not lose control of waiting times– we will ensure
they are kept low.
We will not cut spending on the NHS – we will increase it.
We will not sell-off the NHS and create some American-style
private system - we will ensure competition benefits patients.