NHS Reform and the Healthcare Landscape

Dr Tim Ringrose

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1948World Health Organization (WHO) is establishedMahatma Gandhi assassinatedCommunists seize power in CzechoslovakiaOrville Wright diesOlympics held in LondonAlice Cooper, Olivia Newton-John & Prince Charles bornWarner Brothers shows the first color newsreel Columbia Records introduces the long-playing (33-1/3 RPM) recordCortisone introduced as an arthritis treatmentAllergan founded

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1948

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Satisfaction with the NHS:1997 – 34%2009 - 64%

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So what’s the problem?

Ageing population

Chronic disease

NHS architecture

Expectations

Free at point of care

Public health

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Population pyramid

The pill

Baby boom

1:1

2:1

ONS 2009

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• Strengthening commissioning of NHS services

• Increasing democratic accountability and public voice

• Liberating provision of NHS services

• Strengthening public health services

• Reforming health and care arm’s-length bodies

Equity and Excellence: Liberating the NHS July 2010

“Patients at the heart of everything we do” Focus on clinical outcomes Empower health professionals Reduce management

Key HighlightsRemove targets which have no clinical justification

GP consortia to commission services

Patients to have more control of health records

Move to evidence-based outcome measures

HealthWatch - National and local – patient advocacy

Further pilots of personal health budgets

Personalised care with shared decision making

Remove GP practice boundaries

Patients to rate hospitals and have choice of provider

Equity and Excellence: Liberating the NHS

Giving responsibility for commissioning health care to GPs and their practice teams working in consortia

The creation of an independent NHS Commissioning Board to allocate resources to and oversee GP consortia

The abolition of strategic health authorities (SHAs) and primary care trusts (PCTs)

The introduction of an outcomes framework for holding the NHS Commissioning Board to account

The transfer of responsibility for public health to local government

Greater freedoms for providers of health care and an aspiration to see more social enterprises

The creation of an economic regulator that will set prices, promote competition and ensure continuity of essential services.

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Are GPs equipped? Privatisation

Public Health?

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How did doctors respond?

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24% agree

October 2010, 500 GPs and 500 Hospital doctors

Only 22 per cent of doctors believe that the NHS will be able to maintain its focus on increasing efficiency while implementingthe proposed reforms

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Best ways for NHS to achieve efficiency savings

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Response from medical groups took some time to crystallise

“The BMA has major concerns about many aspects of the Health and Social Care Bill and has been a vocal critic warning

about the most damaging of the proposals, including the highly damaging role of Monitor in promoting competition.

Doctors attending yesterday’s SRM reaffirmed the widespread concern about the plans and because of this

called on the Secretary of State to withdraw the Bill.”

"Clearly, the changes proposed are significant and wide ranging. Many consider the White Paper to be something of a large curate’s egg; good in parts, bad in parts, unclear in parts

and even internally inconsistent in parts.”

July 2010

March 2011

BMA

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Growing alarm from all sides

“The sheer scale of the ambitious and costly reform programme, and the pace of change, while at the same time being expected to make £20 billion of savings, is extremely risky and potentially disastrous”

Peter Carter, Royal College of Nursing

“There are clear risks of introducing GP commissioning when the government has placed such a strong emphasis on reducing management costs.”

Jennifer Dixon, Nuffield Trust

“Cameron should get real and start listening to the people who know about the NHS August.“

Dave Prentis, Unison

“extraordinarily risky”

NHS Confederation

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April –2nd Health Select Committee report on commissioning

Broaden the composition of commissioning groups

Ensure public accountability Encourage integration between

primary and secondary care

“The government’s plans to reform NHS commissioning needs to be significantly changed”

Stephen Dorrell

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Secretary of State must remain ultimately accountable for the National Health Service.

Commissioning consortia to have a governing body that meets in public. There must be effective multi professional involvement in the design and ‐

commissioning of services working in partnership with managers – “Senates”. Experienced managers must be retained. Commissioning consortia should only take on full range of responsibilities when

they can demonstrate that they have the right skills, capacity and capability to do so – extend timetable

Monitor to support choice, collaboration and integration rather than competition. Private providers should not be allowed to ‘cherry pick’ patients. Better integration of commissioning across health and social care should be the

ambition for all local areas. Independent, expert public health advice at every level of the system.

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“The fundamentals of our plans – more control for patients, more power to doctors and nurses, and less bureaucracy in the NHS – are as strong today as they have ever been. But the detail of how we are going to make this all work has really changed as a direct result of this consultation.” David Cameron

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Government’s response to the recommendations

Wider involvement in clinical commissioning groups Stronger safeguards against a market free-for-all Additional safeguards against privatisation Evolution, not revolution Greater information and choice for patients Breaking down barriers within and beyond the NHS Investing for the future of the NHS

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Where now?

Did we really need a health bill to do this? Is this too little to address the structural changes

needed? Is there enough to encourage integration of

healthcare? Is there enough emphasis on public health? Is this addressing the financial challenges? What role will private providers play? What is the role for pharma?