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Shifting the Balance of Power


2.21 The NHS Plan sets out a vision for service designed around the patient - a service of high quality and national standards which is fast, convenient and uses modern methods to provide care where and when it is needed. Such a service will not only be designed around patients but also be responsive to them, offer them choices and involve them in decision making and planning.

The Secretary of State announced on 25 April 2001 a programme to shift the balance of power within the NHS away from central government and towards front line staff and their patients. Under the arrangements set out in Secretary of State's Shifting the Balance of Power speech local clinicians and managers, working in Primary Care Trusts and NHS Trusts, were to be empowered to ensure that local services reflect the needs of the local community. 'Shifting the Balance of Power' is about putting patients and staff absolutely at the heart of the NHS by empowering them and changing the culture and structure of the NHS to reflect this.

Preparing for change

In July 2001 the Department published Shifting the Balance of Power within the NHS - Securing Delivery, (2.29) detailing the proposed changes and inviting responses in a discussion period. Over 400 responses were received from the service as well as the major national representative bodies. There was general support for the direction of change, although there were many queries about the detailed implementation of the proposals. Shifting the Balance of Power - the Next Steps(2.30) was published in January 2002. This document addressed the major issues raised in the discussion period. It set out the framework and principles for the changes but - inline with its own philosophy - left the practical arrangements, the how, when and where of working arrangements and service delivery - to be decided locally. Consultation on the boundaries of the new Health Authorities took place in Autumn 2001 and the new boundaries were subsequently confirmed along with the Chairs and Chief Executives (designate). Franchise plans were then developed by the Chief Executives outlining how they intended to run their organisations, based on a specification set by the Department.

Structural changes

Much progress has been made in developing and implementing the structural changes:

  • England's 95 previous health authorities were abolished on 1 April 2002.
  • Much of the planning and commissioning work previously carried out by these health authorities has been passed to just over 300 Primary Care Trusts, which by 2004 will be controlling over 75 per cent of NHS funding.
  • 28 new health authorities (set to become Strategic Health Authorities in October 2002, subject to legislation) serving populations of around 1.5 million were also established on 1 April, responsible for developing strategy and performance managing PCTs and NHS Trusts, so as to secure delivery and consistency of approach. They will in effect manage the NHS locally on behalf of the Department.
  • The Department of Health has also been re-focusing to reflect the new structure. Four new Directorates of Health and Social Care became operational on 1 April with responsibility for working directly with the NHS and performance managing the new Health Authorities while the Regional Offices are to be abolished.

As a result of these changes, £100 million will be freed up by 2004 to spend on childcare facilities for NHS staff as an aid to recruitment and retention.

Delivering the NHS Plan

Plans for devolving power to locally run services - within a framework of clear national standards - were strengthened in the Department's Delivering the NHS Plan - next steps on investment, next steps on reform (2.31) document, published in April 2002. This document builds on the structural and cultural changes of Shifting the Balance of Power.

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