The NHS White Paper
2010
A system not
structure
Outcomes
focused
Enhanced
local voice
Robust Quality &
Economic
regulation
GP
Commissioning
PBR
Empowered
professionals in
autonomous
providers
Informed
Patients
choice
Equity and Excellence
Key Provisions
• Putting patients first - Shared decision-making, choice, increased
personalisation, collective voice of patient
• Improving healthcare outcomes - abolish targets in favour of outcome
measures, quality standards to inform commissioning, money following
patient, providers paid according to performance
• Autonomy, accountability and democratic legitimacy - devolve
commisssioning to GPs, set up NHS Commissioning Board, promote of
staff-led social enterprise, CQC strengthened as inspectorate, ring-fence
public health budget
• Cutting Bureaucracy and improving efficiency - £20bn effiency savings to
be re-invested to support outcomes, 45% reduction in management costs,
reduce number of DH/NHS organisations
Accountability
Funding
Department of
Health
NHS
Commissioning
Board
Monitor
CQC
Licensing
Local
Authorities
GP Commissioning
contracts
Consortia
Partnership
Local
HealthWatc
h
Patients & Public
Providers
NHS Commissioning Board
• Accountable to the Secretary of State, paving the way for the abolition of
SHAs.
• Will develop the NHS Outcomes Framework:
– A comprehensive set of indicators, reflecting the quality standards
developed by NICE
• Will commission dentistry, community pharmacy and primary ophthalmic
services and maternity
• Will commission national and regional specialised services, influenced by
GP consortia
• Will calculate practice-level budgets and allocate these directly to
consortia.
• Will be responsible for holding consortia to account for stewardship of
NHS resources and for the outcomes they achieve as commissioners
• There will be a duty to establish a comprehensive system of GP consortia
Public Health
• The current performance regime will be replaced with separate
frameworks for outcomes that set direction for the NHS, for public health
and social care, which provide for clear and unambiguous accountability,
and enable better joint working.
• The Secretary of State, through the Public Health Service, will set local
authorities national objectives for improving population health outcomes.
• Local authorities will determine how best to secure those objectives,
including by commissioning services from providers of NHS care.
Local authorities’ responsibilities
• Promoting integration and partnership working between the NHS, social
care, public health and other local services and strategies
• Leading joint strategic needs assessments, and promoting collaboration
on local commissioning plans, including by supporting joint commissioning
arrangements where each party so wishes
• Building partnership for service changes and priorities.
• As well as elected members of the local authority, all relevant NHS
commissioners will be involved in carrying out these functions, as will the
Directors of Public Health, adult social services, and children's services.
• They will all be under duties of partnership.
• Local HealthWatch ensure feedback from service users is reflected in
commissioning plans.
Directors of Public Health
• Local Directors of Public Health will be responsible for health
improvement funds allocated according to relative population
health need.
• The allocation formula for those funds will include a new
“health premium” designed to promote action to improve
population-wide health and reduce health inequalities.
• Director of Public Health will be jointly appointed with the LA
and the Public Health Service
• PCT responsibilities for local health improvement will transfer
to local authorities
GP commissioning consortia
• GP commissioning on a statutory basis, with powers and duties set out in
primary and secondary legislation.
• Every GP practice will be a member of a consortium
• No size indicated – likely to be minimum population of 100 – 150k so – 3500 consortia
• Consortia of GP practices, working with other health and care
professionals, and in partnership with local communities and local
authorities, will commission the great majority of NHS services for their
patients.
• Each consortium will hold its constituent practices to account against
these objectives.
• They will not be directly responsible for commissioning services that GPs
themselves provide, but they will become increasingly influential in
driving up the quality of general practice.
• Will be overseen by NHS Commissioning Board
Providers
• All NHS Provider Trusts to become Foundation Trusts
• Strong pressure to use social enterprise models
• ‘Any willing provider’ concept
Regulation
Monitor
CQC
• Promote competition
• Set maximum prices
• Maintain continuity of
care
• Quality
• Safety
Any Willing
Provider
Foundation Trusts
Private Sector
3rd Sector
Primary Care
HealthWatch England
• A new independent consumer champion within the Care Quality
Commission.
• Local Involvement Networks (LINks) will become the local HealthWatch
• Local authorities are to fund local HealthWatch groups.
• Enhance the role of local authorities in promoting choice and complaints
advocacy, through the HealthWatch arrangements they commission.
When will this happen?
• In 2010/11: GP consortia to begin to come together in shadow form
(building on practice based commissioning consortia, where they wish).
• In 2011/12: a comprehensive system of shadow GP consortia in place and
the NHS Commissioning Board to be established in shadow form.
• In 2012/13: formal establishment of GP consortia, together with
indicative allocations and responsibility to prepare commissioning plans,
and the NHS Commissioning Board to be established as an independent
statutory body.
• In 2013/14: GP consortia to be fully operational, with real budgets and
holding contracts with providers.
Implications for disabled children
• Discussion today
• Council for Disabled Children – briefing paper with commentary and
questions for consideration
• Response to consultation on proposals by 11 October 2010
NHS Alliance Conference
Slide here
References
Department of Health (2010a) Equity and Excellence:
Liberating the NHS. Cm7881.
Department of Health (2010b) Transparency in
Outcomes – A framework for the NHS.
Department of Health (2010c) Liberating the NHS:
Increasing democratic legitimacy in health.
Department of Health (2010d) Liberating the NHS:
Commissioning for patients – consultation on
proposals.
Department of Health (2010e) Liberating the NHS:
Regulating healthcare providers.
Department of Health (2010f) Liberating the NHS:
Report of the arms-length bodies review.