Live webchat with Steve Field

Steve FieldUpdate 21 December 2011: The transcript of this webchat has been temporarily removed in order to prevent unsolicited pop-up advertising appearing. We will re-publish the transcript soon.

Steve Field, chair of the NHS Future Forum,  answered your questions in a live webchat on Monday 9 May.

The entire webchat, including the questions that Steve wasn’t able to answer are published below. All the questions, including the ones sent by email, are regarded as part of the listening process and they will be fed into the discussions of the NHS Future Forum.

In Conversations, News, NHS Future Forum, Steve Field | Tagged ,

44 Responses to Live webchat with Steve Field

  1. Anthony Smith says:

    Hi,

    Why does the NHS does not start to charge patients for every apointment that they are unable to attend or did not attend.
    I work in a NHS hospital and DNA rate can be up to 10% in some parts of our country. This would surely help to repair NHS finances instead of cutting posts and closing hospitals! The NHS would be still free at the point of care however citizens might finally become more aware and respectful towards the NHS itself!!!!

    Why does the idea of Foundation Trusts is not developed further. As far as I am aware these kind of hospitals do make profit and could therefore become self-sufficient from the financial point of view? Why are we being told that there are financial problems if Trusts are actually making money?

    Why not to allow Foundation Trusts to treat private patients allowing them to have agreements with private insurance companies?

    • John says:

      Qoted DNA rates at hospital are a joke.

      When i ask the majority of my patients why they didn’t attend. they tell me they have had that appointment cancelled and a new appointment sent

  2. Steve H says:

    The comments made by Anthony Smith are perfect example of what is wrong with the NHS. It’s full of ‘IDEAS’ people who dream up schemes to ‘IMPROVE’ the customer experience. This breeds thousands of paper pushers and none medical staff. What the customers want is to be seen quickly, not get secondary infections….and preferably not have to pay for parking a car……while we WAIT. They should limit the number of non medical staff to a small %age of the active medical staff. Let’s start at <1% then reduce it further

    • Colin Kelsey says:

      Unfortunately this is indicative of the lack of awareness across the issue concerning the NHS. The number of management posts is largely defined by the need for the Government to understand “why clinicians did something they were not supposed to have done”, “why clinicians did not do something they should have done” and “why clinicians did not do what they should have doen quickly enough”.
      The answers would appear to be to remove the checks and balances and then nobody will know what they did, why they did it or if they did it quickly enough – good plan !

    • S. Marsh says:

      I agree with Colin Kelsey in principal.

      You cannot move forward with any confidence without feedback statistics.

      Whilst all professionals should manage their department to given standards / specification. I have only come across a small percentage that are genuinely interested in the NHS rather than building their own empire / self importance.

      So administrators [as most general managers were called] are a necessary evil but must succumb to sterilisation.

  3. Tony Russell says:

    Why are there no representatives from front line mental health service user groups on the futures forum and can you not differentiate between userled organisations run by people who actually experience the illness they represent and big service provider charities.

  4. Felicity Owen says:

    The NHS reforms see public health move from the NHS to local authorities in order to deliver more extensive health improvement programmes. How can we ensure that this move does not result in a reduced function? At present many local authorities are indicating they will put directors of public health under directors of adult social care which belies the tenets of the reform.

  5. Sally C says:

    1. What specific validated evidence base and risk assessment(s) have been relied on to provide assurance to the public elected Parliament that:
    a. the current system of health and social care is not improving in terms of access to and quality of services provided?
    b. commissioning consortia, price competition and competing service providers will lead to benefits for health and social care service users? What validated evidence is there that previous attempts to devolve commissioning responsibility to GPs (e.g. fundholding and latterly practice-based commissioning has been unequivocally successful in terms of sustained improvements in access, equality and quality of health or social care?
    c. implementing commissioning consortia, price competition and competing service providers at this pace will not lead to instability or inequality of access to or quality of health and social care for any sector of the population, particularly at this time of unprecedented financial pressure?

  6. Sally C says:

    2. What will be the specific governance and/or legislative arrangements to provide assurance to publically elected Parliament and the public that the regulator(s) will ensure:
    a. the commissioning consortia will provide better value for money, including reduced spending on the commissioning process and support, and only re-investment any profit into improving health and social care for non-private sector service users, and any profit will not be used as financial incentive to the commissioning consortia?
    b. commissioning consortia will not have any conflict in interest in terms of health and social care provision? For example as independent contractors and not NHS employees, how many GPs and/or GP Practices have already aligned themselves with independent service providers? This would be the very same conflict that has quite rightly lead to large sections of services provision being separated form the current Primary Care Trust commissioning function.

  7. Sally C says:

    What will be the specific governance and/or legislative arrangements to provide assurance to publically elected Parliament and the public that the regulator(s) will ensure:
    a. the regulator(s) will ensure that in terms of transparency, any information companies can “exclude from publication… commercial information” will not damage the proper scrutiny of new providers?
    b. commissioning consortia will not pay a preferential price to any potential providers?
    c. the management costs associated with commissioning consortia (whether direct or sub-contacted) will reduce by the alleged £5 billion over this Parliament alone

    • S. Marsh says:

      You still require “managers” whether you use contracted services or in house services, as contracts and specifications have to be drawn up and supervised.
      What most authorities overlook is the cost of supervising contracts.
      We do not have transparency now and I doubt if we ever will – too many covering their backs and interests

  8. Sally C says:

    What will be the specific governance and/or legislative arrangements to provide assurance to publically elected Parliament and the public that the regulator(s) will ensure:
     will ensure that value for money rather than price competition is the priority, and that potential service providers will be asked to produce a validated evidence base of improvement in value for money, enhanced quality of services, improved choice, and improved access to services prior to becoming a health and social care service provider?
     health and social care could be taken back into the public sector should the evidence show that open competition and/or commissioning consortia do not improve quality of or access to health and social care services?
     will ensure that the ethos of the NHS is maintained and that there is no avoidance of some procedures or services where the profit margins are lower?
     will ensure that removing the cap on private sector income will not have an adverse affect on access to services by non-private sector health and social care service users?

    • S. Marsh says:

      The answer is in the hands of those who make a list of approved contractors/providers.

      And the people that draw up the contracts and specifications. The strength of a contract is in the wording of the specification
      A “form of contract” covers the type of work ; when ; where ; cost ; conditions etc.
      A “specification” gives all the detail ; standards etc

      Any contract [ be it for materials and / or services] should be managed by those that draw up the contract and specification.

  9. Sally C says:

    What will be the specific governance and/or legislative arrangements to provide assurance to publically elected Parliament and the public that the regulator(s) will ensure:
     will ensure that a range of commissioners does not create a ‘postcode lottery’ in which geographical variation will increase with a lack of local and regional oversight to ensure the consistent equitable quality and availability of care?
     will ensure that a range of commissioners does not compromise safety and that the commissioning consortia will be able to take care of crucial issues like resisting a swine flu pandemic in the way that the NHS has been able to in its current form?
     will effectively scrutinise, monitor and control any increase in foundation trust borrowing when the borrowing limits are removed?

    • S. Marsh says:

      True, you cannot manage some 1600 or so hospitals ; goodness knows how many GPs and all the social care centres, from one office. There has to be some kind of regional office.
      It is just as unavoidable as having NATIONAL officers who are held responsible for EACH profession’s quality inspection of standards, efficiency and costs .
      And yes it is a NATIONAL service not a POST CODE service – as many clinicians would like.

  10. Sally C says:

    What will be the specific governance and/or legislative arrangements to provide assurance to the public that:
     in terms of transparency the NHS Commissioning Board will have patient, public or staff representatives?
     the new Health and Wellbeing Boards will be able to express real democratic accountability and transparency by having the majority of the Board elected rather than “at least one” as currently stated?
     the new Health and Wellbeing Boards will be able to express real democratic accountability and transparency by having representatives from education and trade unions (to ensure the staff voice is heard)?
     the new Health and Wellbeing Boards will be able to have genuinely joined up services across all areas if joined up working and integration of services is only to be “encouraged”?

  11. Sally C says:

    What arrangements are being put in place for transparent, timely public scrutiny and benchmarking of the effectiveness and efficiency of commissioning consortia in terms of:
    a. health and social care provision unit costs
    b. management unit costs
    c. outcome measures including unmet need

  12. Patients Council says:

    We are already in danger of “Not Listening”. We have the same people/groups as always feeding in and heading up such department of health events, we seem very southern based again.
    We must listen to current service users, not representatives! We must reach the hard to reach. Current events do not enable hard to reach people to attend. (I question why LINks have not been asked across the country to hold such an event and feedback)
    If we are to be open and transparent, then we need to enable real service users voices to be heard. We must obtain the views of all GPs and Consultants not just the ones that say yes. We need to listen to our current Primary Care Trusts to seek their views on if these proposals will work.
    We must stop changing and/or moving services, before we have a clear plan and are confident the changers are financially viable. Most importantly, we must ensure we obtain a representative voice, and listen to more than the few voices we obtained for the whitepaper. We must apply the government’s four new tests in every local authority area to ensure we have listened to measure if this has been achieved.

    • S. Marsh says:

      I agree, I would propose the “Listening Team” read the website – NHSexplained.co.uk Very down to earth.

  13. Anita Harris says:

    Will Steve please explain how the forum will include the voice of the NHS ‘frequent flyers’ in their discussions? POhWER members are largely from the frequent flyer groups – in a survey that was used to inform their response to Equity and Excellence, completed by more than 700 of our members, more than 60% had a disability, more than 60% had been an inpatient and 100% had seen their GP during the previous 12 months. POhWER is also one of the three ICAS providers (the national, statutory Independent Complaints Advocacy Service) that has provided information and support to more than 75,000 people who were concerned about the care they had received from the NHS over the last five years. Our members have some anxieties about the planned changes that will affect them in much more profound ways than the general population and are concerned that their views are not being routinely sought. They would also like to know if/how ‘any qualified providers’ will be required to take their views into account on an ongoing basis.

  14. P Taylor says:

    I listened to the interview Steve Field gave on radio 5 earlier today. In the interview, he conceded that it was important to be un-political in his role and any future reports he submits. Yet, he stated that the homeless and travelers who he personally champions will feature heavily.

    Surely his pet projects shouldn’t take priority over the rest of the country, if he took on this role with an agenda then should step down in favour of an impartial chair person.

  15. Steve,

    Each government seems to believe that restructuing NHS management is the ‘solution’ to health.

    Isn’t the problem of ill health in this country a result of complex social and environmental issues (poor housing; lack of education; the vulnerability of isolation and lack of advocacy)?

    Marmot’s proposals were eminantly sensible – ultimately that health needs to be reconsidered through a social rather than a merely medical lens. Do you agree, and if so, what ought a Health Bill do to help create that shift?

    Best wishes,

    Fiona Sheil (NCVO)

    • John Pantall says:

      In September 1980 I raised the local implications of the Black report at a Stockport Council meeting; 30 years later we discussed Marmot. I do believe the Health and Wellbeing Board can provide the opportunity for looking at the wider determinants and tackling effectively the reduction of inequalities.

      However the danger is that as in the past we get locked into only a narrow range of themes – Alcohol, Tobacco, Drugs… Even with simple matters such as 30 minutes or 2 miles walking per day raised in both Black and Marmot we have failed to progress.

      So lets use our HWBs. effectively.

  16. miss c moser says:

    Successful commissioning will depend on the involvement of all healthcare professionals. Allied health professionals must be represented in all key decision making structures at national, regional and local levels.

    What plans do you have for the involvement of representatives of the allied health professions in (a) commissioning and (b) service provision?

  17. John Pantall says:

    The view expressed by Ms Moser regarding successful commissioning
    raises a couple of issues.
    1. There are many examples where both health and social care professionals should be involved. Care pathways ,for example stroke help identify the contribution.
    2. GPs are generally very knowledgeable about certain diseases such as diabetes; however in areas such as dementia and mental health their interest and knowledge is unfortunately very variable. Commissioning arrangements must reflect this.

    • S. Marsh says:

      I and almost every one I speak to say the same – GPs should be just that GPs – not masters of the NHS.
      Commissioning details should be a separate service available to all professionals and the public. GPs and all professionals, should not have the time to get involved in the detail, only contribute to the drawing up of contracts and specifications and the presentation of the information.

  18. Chris says:

    Do you think the outcomes and recommendations of the Listening Exercise will be perceived as credible when the two visible leads of the forum are clearly on record as being behind the reforms in their pre-consultation state?

    So far, what we have seen appears to be an ‘explanation’ exercise (because we, the public, have misunderstood what the clever politicians are trying to tell us), rather than a ‘listening’ exercise (where the public and professionals are recognised as having insight into the serious flaws that many feel the bill has)

    • Chris says:

      Quite disappointed with Professor Field’s response to this question. Of course people are in favour of public and patients being involved, and using a truism to justify what are becoming increasingly recognised as dangerous reforms feels like quite a lazy response. I’d hope he’s realised by now that he’s meant to be listening about whether the reforms are the right way to achieve this.

      I’d challenge him to demonstrate that the public record comments of those heading up the futures forum fairly reflects the commentary, because all I’ve heard from them is a constant song that ‘everything’s fine, but bless, you all haven’t understood it’

      I’m not encouraged by the weighted confidence to one side of the argument from his response. It’s a beautiful cameo of why the forum appears to only have one ear, that is interested in listening to the positives.

    • S. Marsh says:

      That remains to be seen, many believe we are in the usual political plan of “Having consulted the wider field of opinion” – “We are going to follow the broad opinion” – and do what we want as you do not know the actual result of the exercise.

  19. Claire Johnston says:

    I graduated last June as a Speech & Language therapist. The N.H.S paid for my training like many others and now as a result of the cuts we are unable to get jobs. With more students due to qualify in the next few months you are going to have a saturated unemployment market that you have paid to train. Demand to see a SLT is outstripping capacity to see clients. The Matrix report by RCSLT shows the value for money service we provide and how the long term effects of the cuts will cause more financial strain on society. So why are you cutting services after all of the investment that has been made to train us? Its all very short sighted, Cuts now regret later!

  20. wendy.lockwood@tiscali.co.uk says:

    If GP practices are not required to sign up to the new commissioning consortiums who will commission services for their patients? While it makes sense to allow GP’s to choose if they wish to be hands on commissioners, or remain just seeing patients someone has to take the decisions on what services their patients can access. It surely therefore makes sense for them to have to be affiliated to a GPCC in there area unless the intention is to rethink the whole proposal to give the responsiblity for commissioning decisions to GPs.

    • S. Marsh says:

      This proposal is all based on the assumption that you can cap healthcare budgets. At the moment some GPS are more interested in their budgets than the health of their patients. Hospitals discharge patients on the correct drugs which GPs override and prescribe ineffective drugs so they keep within budget. But the patient deteriorates and needs 24 hour care etc.

      You cannot cap healthcare, only the cost of each intervention and limit / refuse treatments.

  21. Hannah Flynn says:

    The NHS Future Forum involves listening exercises with groups of health professionals. Are any planned with pharmacists?

    Also, how do you plan to iron out the lack of clarity over who is a private or NHS provider?

  22. Corinne Camilleri-Ferrante says:

    How will the needs of the unregistered population be covered with the new arrangements? If Consortia do not need to be contiguous, GPs do not have a duty to register, and the SoS does not have a duty to provide, it seems to me that the most disadvantaged could find themselves unprovided for.

  23. Duncan Roberts says:

    What possible justification is there for enfeebling NICE and scrapping practice boundaries at the same time? This is the least talked about issue in the press and it is the most disturbing. Had the Conservatives not had the courtesy to keep it quiet and wrap it in the false dilemma of “choice” it would read simply as a bold-faced attack on the poor, the elderly and the infirm. This runs directly counter to the stated aim of tackling health inequalities, not only will it reintroduce the postcode lottery but it will result in internal medical tourism available only to the healthy and mobile.

  24. Ashley Liston says:

    Hi Steve

    Firstly many thanks for taking on this role. You have earned huge respect for your work when you chaired the RCGP and provided exceptional leadership. I cannot think of better person to head up this group.

    My real concern is regarding the future model of general practice. If as seems likely there will continue to be a market approach to procurement of health services and there will be a significant move of services from secondary care to primary care it seems likely that GPs will struggle to compete to provide services which may incrementally remove significant parts of traditional GP services.

    The college has been encouraging GPs to ‘federate’ in order for them to place themselves in a viable position to bid for community services. Very few GPs are doing this as they are mainly preoccupied with the commissioning process and also the increasing threats that exist to their small businesses.

    Is there a future for the small ‘cottage industry’ approach to GP where personal, relationship based health care flourishes best?

  25. Ben Anderson says:

    Two questions,
    1) If Public Health directorates transfer to the local authority how will the benefits this offers in tackling the wider determinants of health be assured, and how will commissioning support organisations be set up to access the significant health care public health contribution (in the form of needs assessment, appraisal of evidence, care pathway design, evaluation and management) that these directorates currently make to controlling costs and improving outcomes.
    2) If health care commissioning is no longer going to be a public service role, how will comercial interests be managed when brokering the provision of integrated care pathways between a range of provider organisation to ensure that services are commissioned in the public interest, and how will these organisations be held to public account?

    • F.Maddison-Roberts says:

      Agree. This is the basic threat to a true NHS.There is so much being proposed that the underlying threat, yes it is a threat, is not being recognised by many.

  26. Steve

    The BMA GPC recently stated a policy that patients should pay as little as possible to access NHS services, but that this must be balanced by the quality of service provided.

    (I am sure that Tesco would say the same about groceries.)

    Does this reflect the general view of the profession and can we expect more underhand charging by GPs as a result of the reforms?

    (I refer to 0844 telephone numbers, as used by at least one of your colleagues on the Future Forum.)

  27. Nick says:

    Dear Dr Field,
    First of all, thank you for taking on this role – I just hope you’re “listened to” at the end of it!
    As far as I can work out after 18 years in the NHS, the only thing that seems to make a significan difference in patient care, delivery and outcomes is funding. Reforms are at best neutral, or at worse detrimental. And they syphon off a significant amount of funding.
    I see no reason why this should be different.
    Also, the headline statements from A Lansley & co about patient choice etc sound eerily similar to New Labour’s pronouncements, which bore no relation to reality: choice got worse if anything.
    Finally, we’ve already had several scandals (quickly buried) where private contractors caused damage to patients (eyes, hips etc), but because they’re not covered by the same regulations as the NHS they didn’t undergo the same level of scrutiny. Won’t opening things up even more to market forces increase the risks of more disasters, all for the sake of profit?
    Basically market and health don’t go together. Market dominates, health suffers, profits grow.

    • S. Marsh says:

      That is the fault of the person that approved the contractor / provider and who drew up the contract and specification. The NHS has always been good at hiding its faults. When clinicians complained about faults in other services we used to say – we never see your faults because you bury them.

  28. Eddie Jaggers says:

    Why is there Commissioning of Health Services in England? The rest of the UK dont have such a system.

    Has a financial anyalsis been undertaken, including all the costs associated with commissioning, as to the cost effectiveness of Commissioning?

    • S. Marsh says:

      Exactly, before embarking on all these many changes one should ensure the existing is working as intended and ALL professionals are ensuring their department is working efficiently. Only then can you identify what needs changing. If you read all the former NHS PLANS you will see there is a hidden assumption that the service is only 33%+ efficient and it is on that that all the cutbacks are based.