Quick guide to health and care reform

Why is it happening?

Much of the health and social care system is excellent but England falls behind many of its European neighbours on a number of key health measures, such as cancer survival rates. Our health and care system needs to deliver an improved service with better results for patients:

  • there needs to be more focus on improving quality, as poor quality care costs more money – if hospital acquired infections are not tackled, or if there are no steps to prevent falls among older people, it can cost the NHS billions of pounds every year
  • services need to be joined up more effectively – patients who need support from both health and care professionals too often find their needs aren’t met, because health and social care professionals don’t work together locally
  • about half of all deaths in this country are preventable, so more needs to be done to encourage people to look after their own health by eating well and exercising more
  • health costs are rising because of an ageing population and advances in medical technology so steps need to be taken now to cut waste and improve performance.

What does it mean for the patient?

‘No decision about me without me’ will be the principle behind the way in which patients are treated – patients will be able to make decisions with their GP about the type of treatment that is best for them. Patients will also have more control and choice over where they are treated and who they are treated by.

They will be able to choose their:

  • GP
  • consultant
  • treatment
  • hospital or other local health service.

Patients will be able to get the information they need, such as how well a hospital carries out a particular treatment, to help them decide on the best type of care. If patients are unhappy with their local hospital, or other local services, they will be able to choose another one to treat them.

Patients will be able to rate hospitals and clinics according to the quality of care they receive, and hospitals will be required to be open about mistakes and always tell patients if something has gone wrong.

Patients will have a strong collective voice through a national body, HealthWatch, and in their communites through arrangements led by local authorities.

What does it mean for the public?

The public will be able to have more influence over what kind of health services should be available locally. They will also have greater opportunities for holding to account local services that are not performing well.

They will be able to get more information about how their local health services are performing, such as how well their local hospital carries out a particular operation or treatment.

There will be more focus on preventing people from getting ill – the Public Health Service will pull together services locally to encourage people to keep fit and eat more healthily.

What does it mean for GPs and other primary care clinicians?

GPs will be responsible for designing local services for patients – they will decide, for example, what services are needed for patients with asthma or diabetes or how pre- and post-operative care can be best organised.

Working with other local clinicians, GPs will take over from managers in Primary Care Trusts as the people who buy health services for patients.

GPs will also be more directly accountable to patients, who will be able to choose any GP practice they like, regardless of where they live.

What does it mean for hospitals and other health service providers?

Providers of hospitals and other services will have greater freedom and fewer centrally set targets. They will be paid according to their performance and payment will reflect results – this will provide an incentive for greater quality.

If they provide a good service that is popular with patients, they’ll be able to grow and expand.

Providers will also be able to make more money from different sources of revenue and reinvest it into NHS services.

What does it mean for local authorities?

Councils will have a much greater leadership role in local health services – they will be responsible for local health care priorities, joining up health and care services and ensuring they meet the needs of their local communities

They will work with GPs and others to define what local health priorities should be – whether that’s reducing smoking rates, improving stroke care or maternity services.

They will also have a much more clearly defined role in leading the development of public health services in their area.

How will the new health and care system be run?

Local authorities will be responsible for local health care priorities, while central government will have much less control over health services.

The NHS will be measured by how successfully it treats patients – for example, whether it improves cancer survival rates, enables more people to live independently after having a stroke or reduces hospital acquired infection rates.

An independent and accountable NHS Commissioning Board will be established to:

  • lead on the achievement of health results
  • allocate and account for NHS resources
  • lead on improvements in quality
  • promote patient involvement and choice.

The Board will also have a duty to promote equality and tackle inequalities in access to healthcare.

Monitor will become an economic regulator to promote effective and efficient providers of health and care, encourage competition, regulate prices and safeguard the continuity of services.

The role of the Care Quality Commission will be strengthened as an effective quality inspectorate covering both health and social care. HealthWatch will represent the views of patients, carers and local communities.

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