Pausing, listening, reflecting, improving

The NHS is our most precious national asset. Every second, hundreds of people walk through its doors. Every week it saves thousands of lives. Every year, millions of us rely on it.

However, the NHS faces some major challenges. For instance, if we were performing at world-class levels, the NHS could save 5,000 more lives from cancer, and 2,000 more lives from respiratory diseases each year. Our population is aging, while the cost of advances in treatments and medicines add around £600 million of funding pressure to the NHS budget every year.

Unless we face up to these pressures and change the NHS to adapt to them, we will be taking a risk with one of our most important and most loved national institutions.

We believe in the following principles for change in the NHS:

  1. NHS care will be free at the point of use, based on need not the ability to pay.
  2. There will be no ‘privatisation’ of the NHS. Private companies will be able to get involved, as they are now, but they will not be allowed to ‘cherrypick’ the best services by choosing to provide the most straightforward treatments, leaving NHS hospitals to pick up the most expensive and complex cases.
  3. Our ageing population and the increasing cost of advanced medicines and treatments mean that pressure on the NHS budget is growing. This means that the status quo cannot be an option.
  4. Patients should be centrally involved in making decisions about their own care, on the basis of ‘no decision about me, without me’.
  5. GPs should be much more involved in decisions about commissioning treatment.
  6. Money should be controlled at the NHS front line, with as little bureaucracy and red tape in the way as possible.
  7. The NHS budget should be ringfenced, with real terms funding increases each year.

These are principles that a broad range of NHS professionals, patients and others have said they agree with as a set of fundamental goals for the modernisation of the NHS, centred on improving outcomes for patients, they should remain in place.

We first set our proposals for putting these principles into practice in the White Paper, Equity and Excellence: Liberating the NHS in July 2010. As we make progress with implementation, we are seeking to ensure that the Bill is effective in supporting these principles.  With a break in the legislation now, we are listening and engaging with patients, clinicians and the public, including the new organisations formed to deliver a modern NHS.  We will adapt our proposals in light of engagement and discussion. The engagement process will inform changes to the Health and Social Care Bill and our broader policy and implementation plans.

While we want the debate to be as open as possible, there is also a need for discussions to have a clear sense of purpose. We are therefore suggesting four themes under which they will take place:

1. How can we use choice and competition to improve patient care and how, when and where should the use of choice and competition be extended?

Under this heading we want to know how the NHS can ensure that patients always share in decisions about their care and enjoy increased choice; how patients should have access to whichever services offer the best quality; and how we can make sure that competition is best used to drive up the quality of care, and be best regulated.

2. How to ensure the NHS can be properly held accountable to the public and how to ensure public and patient involvement is built into the heart of the new arrangements?

This will involve discussion around how best to devolve power to the NHS at local level, rather than trying to control it from Whitehall; and how we can make sure that the voices of patients and the public are strengthened in decisions about the NHS and its services.

3. How to ensure advice and leadership from across the range of healthcare professions is at the heart of the new system in order to drive higher quality and more integrated care.

There is broad agreement that front-line clinical staff should lead the design of local services, and that public health should be a key priority. How can we make these aspirations more of a reality?

4. How can new arrangements for professional education and training best support improvements to the NHS?

We know that the needs of patients, and the training and education staff will need to treat them will change in future. We need to discuss how best to set up mechanisms to ensure that these are properly coordinated.

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