On 6 April 2011 the Government announced that it would “pause, listen and reflect” on its NHS reform plans and established the NHS Future Forum to lead the 8-week “listening exercise”. The NHS Future Forum issued its report on 13 June.
In response to the NHS Future Forum report, the Government has announced changes to its NHS reform plans that adopt many of the Future Forum’s proposals and address many of the concerns raised since the publication of the Health White Paper in July 2010.
We welcome these changes, in particular those concerned with accountability and scrutiny that go some way in correcting the flaws in their original proposals and concede many of the objections and suggestions that we along with many others made at the time.
We have produced a brief summary of the Government’s latest proposals – NHS listening whats new
It should be read in conjunction with our briefing, The Health White Paper – what it says, our original response to the White Paper, and our update paper, The Health White Paper – What’s changed?, summarising the changes announced by the government following the consultation on the White Paper, which can all be found on our Health page.
Any reforms to the NHS must follow the key principle that decisions on all publicly funded commissioning and provision should be taken by publicly accountable and open bodies, and should be subject to local authority scrutiny.
We welcome the Government’s confirmation that that health scrutiny should remain independent from the executive, and that both commissioning bodies and Health and Wellbeing Boards will be subject to scrutiny by local authority scrutiny committees.
There is a need for proper governance and transparency of commissioning consortia and of Health and Wellbeing Boards, with a broad membership including elected councillors and representatives of other health professions, not just GPs; and they need to be subject to independent scrutiny, regardless of the composition of their boards.
Further, in addition to the important role of HealthWatch enabling engagement if the wider community, patients and the public need to be involved effectively at every level from the strategic Health and Wellbeing Board, to actual service delivery.
You can see our response to the NHS Future Forum here – NHS FF response
The Royal College of Nursing is the latest group to question whether Andrew Lansley is really listening, as the Government slows the pace of its NHS reforms.
We welcome the news that the Government is ‘pausing to listen’ to concerns about the Health Bill. The key issue that is emerging from the debate that is going on, is that there needs to be more effective involvement and public accountability. Andrew Lansley said today that he wants to listen to and involve nurses, but his plans for the NHS don’t give nurses and other health professionals a clear role in NHS commissioning.
In our original response to the Government’s Health White Paper, we raised concerns about accountability in the proposed commissioning arrangements.
It is not about who actually carries out the process of commissioning, but how the wider health community – those using the services, those providing the services and other stakeholders – are involved in the process. If we are to achieve health provision for an area which reflects the needs of the community, that community, in all its facets, must be included within the process.
The commissioning process needs to be led by a body that is truly transparent and accountable to its community and which directly involves representatives of front line staff and local residents. This body should meet and take its decisions in public; its membership should reflect the make-up of its community; and it should be subject to the Freedom of Information Act.
Tamarind Chambers has issued its response to the Coalition Government’s Health White Paper. The report, led by Mike Cooper, focuses specifically on democratic accountability, scrutiny and governance. Whilst welcoming the general aims of the White Paper to make the NHS more patient centred and give citizens a greater say, the report questions whether this will really be achieved by these proposals.
It concludes that more needs to be done to give citizens, as distinct from patients, an effective voice and the autonomy and freedom must be tempered by transparency and effective local accountability.
The Tamarind report identifies that the White Paper:
- is insufficiently clear about the governance arrangements for the proposed GP Commissioning Consortia
- fails to establish how real local accountability will be achieved
- fails to demonstrate how the local authority/wellbeing boards will exercise its strategic control or have any real say over local NHS commissioning decisions and service provision
- fails to go far enough to join up health and social care services and actually makes NHS and other public health services less joined-up
- places an over-reliance on the market and competition which could stifle co-operation and undermine transparency and accountability
The Tamarind report strongly recommends that GP Commissioning Consortia will require more rigorous governance and clear local accountability and that the power of local authorities to scrutinise NHS decisions and services on behalf of their local community should be retained.
The report also raises concerns about the extent and speed of the changes and calls for continued dialogue and consultation as the proposals are developed and implemented.
The report and other analysis and briefing materials about the Health White Paper can be found on the Health page.