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
We have produced a simple to use and cost-effective toolkit for Local Involvement Networks to carry out a self evaluation to review their performance and identify issues they need to focus in the transition to HealthWatch. We have undertaken a trial of the pack, which was described as “… really good .. the questions were relevant and meaningful … It made us all think about how our LINk is working and how we can make it better…”.
For further details, see our flyer: LINk Self Assessment Toolkit
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.
Liberal Democrats have just voted overwhelmingly in favour of amendments to a conference policy motion on the NHS. Included in the amendments were references to more democratically accountable commissioning, greater transparency for NHS commissioning, for commissioning to be subject to the Freedom of Information Act and that there should be a focus on co-operation not competition.
We made these points in our submission in response to the White Paper, including concerns about the co-terminosity between GP commissioning and local authority areas and the issue of GP commissioners making decisions in private – proper consultation and scrutiny must be part of the process.
Check out our submission on our Health page.
The focus of the current debate on whether the government’s NHS reforms hasten the privatisation of the NHS, is missing the point.
The important thing is not who the provider of a service is, but to ensure the transparency, accountability and scrutiny of the spending of public money.
We are pleased that the government recognised the importance of independent scrutiny, and amended their original proposals to ensure that GP commissioning will be subject to local authority scrutiny – this is something that we, along with many others – proposed in our response to the White Paper.
Our response to the consultation can be found on the Health page.
The government has declared that its proposals to remove powers of health scrutiny from independent local scrutiny committees ‘was flawed’, and that it proposed new health and wellbeing boards and GP Commissioning arrangements should be subject to external scrutiny by elected councillors.
Tamarind Chambers had in its submission on the White Paper strongly opposed the initial proposals to change health scrutiny, and welcomes the government’s new-found commitment to its retention and development. This u-turn has been widely welcomed by local Councils, community groups and independent commentators.
The Health White Paper had proposed that the new health and wellbeing boards could take on the role of health scrutiny, and that the powers of health scrutiny that allow local council scrutiny committees to operate would no longer be required.
However, Tamarind Chambers, along with many others, had pointed out that the current health scrutiny arrangements had proved their value in bringing much-needed accountability and independent challenge to the NHS and enabled genuine public engagement; whereas the health and wellbeing board, with its strategic role in commissioning services, would not be able to provide independent scrutiny, and should actually be subject to scrutiny itself.
In ‘Liberating the NHS: Legislative framework and next steps’, which describes how it will take forward the proposals set out in the Health White Paper, the Government says that it will not transfer scrutiny function to the health and wellbeing board, to maintain the distinction between executive and scrutiny functions; and that it will actually extend the powers of local authority health scrutiny to cover any provider of NHS-funded services as well as any NHS commissioner.
Tamarind Chambers has produced a brief summary of the changes to the proposals in the White Paper, HWP whats changed. This and other comment and analysis can be found on the Health page.
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.