Government response to NHS Future Forum

The Government has announced that it accepts the core recommendations of the NHS Future Forum report and will make changes to its plans for modernisation of health and social care.

The key changes include:

Reaffirming that Ministers are accountable overall.

  • The original duty to promote a comprehensive health service will remain.

Wider involvement in clinical commissioning

  • GP consortia will be called ‘clinical commissioning groups’. They 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 that will provide multi-professional advice on local commissioning plans. Both will be hosted within the NHS Commissioning Board.

Stronger accountability

  • The governing bodies of clinical commissioning groups will have lay members and will meet in public.
  • Foundation trusts will have public board meetings.
  • Health and wellbeing boards will have a stronger role in local councils, with the right to refer back local commissioning plans that are not in line with the health and wellbeing strategy.
  • There will be clearer duties across the system to involve the public, patients and carers.

Safeguards on competition

  • 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.
  • There will be new safeguards against price competition, cherry-picking and privatisation.

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 – for example, 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 patients.

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 foundation trusts  until 2016 to maintain high standards of governance during the transition.
  • There will be a careful transition process on education and training, to avoid instability – more details will be announced in the autumn.

>> See more detail of changes

To ensure that Parliament has sufficient opportunity to scrutinise the Government’s changes, relevant parts of the Health and Social Care Bill will be recommitted.  Further details of this, and the amendments the Government will make to the Bill, will be set out shortly.

Health Secretary Andrew Lansley said: ‘The independent NHS Future Forum has made a number of recommendations and we are accepting them. This has been a genuine exercise and it is clear from our response today that substantial changes have been made in the interests of patients.

‘The Forum confirmed that there is widespread support for the principles underpinning our plans for change: greater patient choice, “no decision about me, without me”, more control for doctors, nurses and frontline professionals, a focus on quality and results for patients, more information and more clout for the public.  These changes now will help us make those principles a reality.’

The Government also today announced the independent NHS Future Forum will continue to lead on listening in the NHS, ensuring an effective communication channel with the NHS.  Among other areas they will focus on education and training; patients’ rights and public health.

>> See press release

In Health and Social Care Bill, News, Pathfinder Learning Network | Tagged , ,

23 Responses to Government response to NHS Future Forum

  1. Michael Vidal says:

    I note in its response the government states ‘Where a clinical commissioning group is not able to take on some or all aspects of commissioning, the local arms of the NHS Commissioning Board will commission on its behalf’ This is the first mention of the NHS Commissioning Board having a local arm. I thought during the committee stage it was stated that the NHS Commissioning Board would not have regional bodies. How are these local arms any different to PCTs?

    • Paul Carroll says:

      One of the great sleights of hand during this whole shambles was the implication that 200 or so consortia could be managed by one commissioning board based in ?Leeds. It was obvious to any manager in the service that this was never doable. That’s why regional authorities of some description have always been around. The only question was the number and the geographical slicing – have been patiently waiting for the day the cat was let out of the bag. Lansley boasted about ‘getting rid’ of 2 tiers of management but another 2 are about to enter the fray (the board and clinical commissioning groups – and we’ll still have one of the cheapest healthcare management systems in the world.

    • Steven Courtney says:

      I suppose it depends how ‘local’ the local arms are. However, the question could stil remain how these local arms will differ from current SHAs (Strategic Health Authorities).

    • A Rodriguez BSc MPhil (Cantab) says:

      Yes, indeed, all the brouhaha over privatisation has overshadowed the central glaring fault in the reforms, the central commissioning board being put in place of regional health authorities. This is a recipe for disaster as it places too much distance between the clinical commissioners and the central board. And isn’t this just reinventing the wheel with a revived NHS Executive in Leeds which New Labour abolished? A devolved structure would have been much better.

  2. A Rodriguez BSc MPhil (Cantab) says:

    The whole idea that the Health Secretary would have been absolved of any statutory responsibility for health beyond a vague remit for public health was absurd (the clue is in the title, Mr Lansley). The NHS is not some stand-alone agency monitoring traffic cones, it is a vital public service. It needs a proactive advocate at the helm, not a silent partner.

    Surely the “Health Secretary” who wanted to wash his hands of health should do the decent thing and step aside as soon as decently possible. Resign!

  3. Rob Hopcott says:

    It was horribly stomach churning to see Cameron, Clegg and Lansley spouting meaningless management sound-bites about NHS reform, forcing hard working NHS staff to stand behind them and preventing these NHS clinicians getting on with their busy and important jobs this lunchtime in an effort to recover political face.

    It now appears that the NHS might possibly be less harmed by the NHS changes that Lansley holds so dear or at least the changes will be slowed down. Probably just the latter.

    It is not enough! The better solution is to call an end to the whole disastrous dogs-breakfast and leave the NHS to do what it is best at doing which is looking after the patients.

    The proposal that the NHS changes will solve problems caused by an aging population and medical care advances quite simply is NOT CREDIBLE. The Government must stop wasting people’s time NOW and leave the NHS ALONE as Cameron promised in his manifesto!

  4. Rod Jarvis says:

    Huzzah! Evolution, is much better, than revolution. Perhaps we will find an N H S, most people, will be happy with.

  5. Alison Lee says:

    How are commissioning groups going to find a registered nurse or hospital specialist who will add credibility to the governing body if they are not employed by a local health provider? Our consortium considered having a local consultant and nurse on their board but decided against because of the significant conflict of interest so instead set up a clinical senate. This seemed sensible but now they have to have a nurse and consultant on the board but not from the local area. This feels like a fudge to me.

    • Michael Vidal says:

      Alison I had the same thought. The only solution would be for you to use a Nurse and Dcotor who lived in the area but did not work in the area. The other way would be to get a Doctor and Nurse from another hospital that you do not send patients too but there a re costs implications in both cases.

    • Tim Kimber says:

      which consultant or nurse in their right mind would want to do this? In my area they would have to travel a minimum of 50 miles to ensure that they did not work for a local provider. So possibly 4 hours travellling time and a poor rate of pay to do……..what exactly?

  6. dennis toye says:

    I do not trust this coalition. The small print will almost certainly try to reaffirm the original proposals. They may well have decided that the short game must give way to a long game.

    There is not enough emphasis in the coverage of the coalitions main objective i.e. to reduce the cost of the NHS

  7. Patricia Wenlock says:

    I just hope that the NHS will be better organised and does not follow any “super scheme” dreamed up in America. eg “SATS” in education, which many teachers like myself disliked from the start as it restricted any fun in learning and individual creativity. The sooner it disappears in schools the better.
    Many of the proposed NHS changes seem to me to entail more people doing “admin” jobs with fewer “on the ground” in surgeries and hospitals. This may be a simplification but why make things more complex. That causes more complications to set in and therefore more funding is needed to sort things out, leaving less funding for patient care.

    • K. Hutchinson says:

      As all the GP’s will be involved in high finance can the government recommend an accountant that I might consult in case of illness?

  8. John Sullivan says:

    As Alan Milburn clearly states, this NHS reform is a total ” car crash”.
    It will not achieve what is promised by government, but then we were promised no top down reorganisation of the NHS before the election. Therefore the fact we are being sold a pup by the government on the NHS is nothing new.
    More competition by any provider will lead to the break up and the privatisation of the NHS, which for me is quite simply the intention of the government. What I fail to understand, is how can these proposals possibly reduce the need for managers + secretary & accountant costs.

  9. Richard Turner says:

    with regaurds to any restructer by any government we only have to look at the shambales of the computer data base that has cost far more than any body ever imagined & still with no posative benefit. Any improvment in the NHS has to be done with both the staff who run it and the end user ( what a lovely term) ie patient involved. Cost will always be a stumbling block for any improvment.

  10. Caroline Batchelor says:

    I do not believe that this bill should be amended – it should be scrapped!

    The PCT staff in commissioning will or are being transferred over to form a group – still paid for by the NHS.( Nearly complete in Sussex) Once the PCTs have completely been fragmented; who will pay for their salaries?
    Answer: Private Companies
    Result: Same people; different host; welcome to any willing provider.

    • Michael Vidal says:

      Caroline I think you will find that if you read the response carefully the government has realisd that they will need some managers to help to do the commissioning. As the Clinical Commissioning group will be barred from delegating the commissioning to private companies what will happen is the PCT staff who have left as a result of this shambles sorry reorganisation will simply offer thier services as contractors doubling thier pay in the process.

  11. Patricia Jerram says:

    Why try to make changes to the NHS now. In my opinion, it has been a successful organisation for many years.
    The more pressure to beat the goverment in their comments the better.
    They should be on their guard, as they only became a goverment by a small margin.!

  12. Valerie Tracey says:

    I will not be happy until the whole bill is scrapped, Cameron has no mandate to mess up our wonderful NHS he lied about his plans for the NHS at election time when Lansley was already setting out plans with private medical firms to carve the NHS profitible parts for them to take. Voters believed it, and as for Nick Clegg saying he has protected the worst parts of it, is another out and out lie of his,he forgets we can remember he signed the first proposals. He only changed his mind to save his job in an unholy allience after the Libs left faction gave him a rough ride at their conference. What has happened to the upright and honest British?.

  13. sandy cooke says:

    Where the private sector is included as an extra to the NHS it works well. I am at present in hospital having had a knee replacement yesterday. In my area the GP offers a choose and book system which meant that when I needed to see a specialist I could access via the telephone a list of hospitals with waiting lists in my area. This meant I could choose one which fulfilled MY needs. The private sector centres appeared as a choice and for locality and timing was the choice I made this time. This is the type of involvement that works well and nothing more formal is needed.

  14. George C.A. Talbot says:

    Steve Field demands substantial changes to the Bill. Although Government accepts the core, many criticisms remain and I deplore its impetuousness on this important matter.

    DH must enable mature resolutions of the endemic conflicts between patients’ demands for more treatment and support, staffs’ demands for good pay and conditions, the need for good equipment and buildings, and society’s limits on spending now and later. Yet despite Field’s claim to support the core principles and values of the NHS, he accepts the purchaser-provider split and introduction of market mechanisms with their split between selfish businesses and responsible governments.

    Field quotes the NHS constitution on patients but ignores staff conditions and PFI capital. He says “GPs should take responsibility for the health of their local populations and the financial and quality consequences of their clinical decisions through a comprehensive system of commissioning consortia.”. I agree GPs should take responsibility for the costs and benefits of their decisions. But commissioning consortia are something else! Many assert GPs should not commission at all and some note the purchaser-provider split has added £10-20bn per year to NHS costs to no benefit. A mature management in an Executive Agency reporting annually to the cabinet would avoid this cost and should choose well, aided by consultations. I prefer competent management responsibility to the notional accountability of clinical commissioning committees.

    I note Field accepts competition as a tool for supporting choice, promoting integration and improving quality, and the principles of ‘assumed liberty’ and ‘earned autonomy’. But few value choice and he should not welcome these free market principles into the English NHS. They liberate businesses to pursue their interests but require governments to take responsibility for outcomes!

    I regret Field forgets the NHS is socialist and values neither disciplined emulation nor subsidiarity. Instead, his text and Government’s reply claim conflicts will be resolved by the national NHS Commissioning Board and augmented commissioning, with efficiency improved with payment by results and pay and conditions worsened by competition although this depresses demand.

    I urge Government to withdraw this Bill, to briefly specify its aims and to invite interested parties to summarise their preferred means of achieving them. From these DH could develop a good solution that should endure. Meanwhile, it should reintegrate Foundation trusts into the NHS and the Treasury should work honestly on the global financial and economic systems.

  15. Michael Vidal says:

    The main reason we have this mess is that the government saw fit to depart from normal practice when there is a major reform of policy and have a green paper whihc contained options whihc could have been the subject of mature discussion. This would have led to a more considered white paper which did not leave so many questions unanswered. In turn this would have led to a bill which was more considered. I await the publication of the amendments to the bill whihc I will consider and reflect on before deciding what further comments if any to make.

  16. Terry Dickerson says:

    A few years ago the former government forced a commissioner-provider split. This split seemed to me to be at best desirable and probably essential if the idea of patient choice was to be a reality. The latest arrangements seem to be trying to heal this split. The Forum correctly pointed out the conflict and has made suggestions to at least make commissioning decision-making a little more transparent. In five years time will this conflict be seen as a major issue and trigger another re-organisation? I expect so.