Patients, prescribers and politicians: a new coalition for the NHS

The BMA has welcomed the pledge to develop a clinically-led health service following an increase in NHS management in recent years, but urged the coalition to deliver beyond rhetoric. “Doctors want to work constructively with the new Government and we are pleased with plans to prioritise clinical engagement with the medical profession. But it is essential that this dialogue is meaningful and does not just pay lip service to the notion of involving clinicians in proposals for the health service,” said BMA Chairman Dr Hamish Meldrum.

Plans to introduce a Health Bill that cements the coalition’s vision for the health service were unveiled in last month’s Queen’s Speech. The Bill, which will be put before Parliament in around 18 months’ time, will propose an NHS run by clinicians and free from political interference. A flagship component will be the creation of an independent NHS Board, which will be responsible for apportioning resources and providing commissioning guidance. It will also give GPs power to purchase services for their patients.

Other measures include increasing the responsibilities of the Care Quality Commission and giving new powers to Monitor to act as an economic regulator “to oversee aspects of access and competition in the NHS”. Further attempts to improve efficiencies within the service will see a reduction in the number of health quangos in a bid to cut administration costs in the NHS by a third.

The Health Bill – at a glance

Purpose:

To build a sustainable national framework for the NHS.

To support a patient-led NHS focused on outcomes.

To reduce bureaucracy.

Benefits:

An NHS led by clinical decision-makers that is more responsive to patients.

A system that drives up standards of care, eliminates waste and achieves outcomes.

A service where patients have greater choice and control in decisions about their care.

Policy:

The establishment of an independent NHS Board to allocate resources, provide commissioning guidance and allow GPs to commission services.

Strengthening the Care Quality Commission and developing Monitor into an economic regulator to oversee access and competition in the NHS.

A reduction in the number of health quangos, cutting the cost of NHS administration by a third.

Targeting key priorities

The Queen’s Speech followed hot on the heels of the coalition’s Programme for Government, which was unveiled by Prime Minister David Cameron and Deputy Prime Minister Nick Clegg shortly after the new Government was formed. The Programme guaranteed a “real term” increase in health spending in each year of the parliament and an end to “top-down reorganisations of the NHS” that it said had “got in the way of patient care”. The Government pledged to stop the “centrally dictated closure of A&E and maternity wards” and give people better access to local health services.

Other measures outlined in the Programme include:

• NICE reform and a move to value-based pricing, so that all patients can access the drugs and treatments their doctors think they need.

• Establishing a Cancer Drugs Fund.

• Strengthening the power of GPs as “patients’ expert guides” through the health system by enabling them to commission care on their behalf.

• Prioritising dementia research within the health R&D budget.

• Setting health targets in key areas such as cancer and stroke survival rates and reducing hospital infections.

• £10 million a year from 2011 to support children’s hospices.

• A new per-patient funding system for all hospices and providers of palliative care.

• An extension of best practice on improving discharge from hospital –maximising the number of day care operations, reducing delays prior to operations and enabling community access to care and treatments.

• Helping elderly people to live at home for longer through home adaptations and community support programmes.

• The development of a 24/7 urgent care service throughout England.

• Giving every patient the power to choose any healthcare provider that meets NHS standards, within NHS prices. This includes independent, voluntary and community sector providers.

Local decision-making

The Programme’s commitment to end an era of top-down NHS reconfigurations and instead give power back to local communities has been highlighted as a key component of change. Health Secretary Andrew Lansley said: “We are committed to devolving power to local communities – to the people, patients, GPs and councils who are best placed to determine the nature of their local NHS services. Local decision-making is essential to improve outcomes for patients and drive up quality.”

Lansley said he expects decisions on NHS service changes to:

• focus on improving patient outcomes

• consider patient choice

• have support from GP commissioners

• be based on sound clinical evidence.

Local NHS organisations that have started to look at changing services will need to ensure their plans match these criteria. Lansley had said he was looking to NHS London, the biggest authority in the health service, to lead the way in working with GP commissioners in their reconfiguration of NHS services. However, the head of NHS London, former GSK Chairman and CEO Sir Richard Sykes, resigned from his position late last month following the new government’s decision to halt a wave of hospital reorganisations. Sykes was said to be furious at the Health Secretary’s decision to scrap a review of healthcare in the capital. The review included the possible closures of some A&E and maternity units.

A mixed reaction

Commenting on the new Programme for Government, ABHI said that the coalition appeared to have dropped the Conservative pledge to scrap NHS targets such as the ‘18 week wait’ but questioned its pledge to stop top-down reorganisations. “The programme does contain significant changes in the shape of an NHS Board and GP commissioning – measures which could have serious implications for NHS structures,” it said.

ABHI highlighted the appointment of Earl Howe as Parliamentary Under Secretary of State for Quality as being significant for industry. The position gives Howe responsibility for medicines, pharmacy and industry, NICE, R&D and innovation. ABHI recently met with Earl Howe to discuss the medical technologies industry and says it looks forward to continuing its dialogue.

Reaction to the recent announcements has been varied. Anna Dixon, Director of Policy at think tank The King’s Fund, said the proposals confirm that the NHS is embarking upon a period of significant change. “Strengthening the role of doctors and the voice of patients will create some difficult dilemmas,” she said. “In setting up an independent NHS board, careful thought will need to be given to the relationship between its responsibilities and those of ministers, who will remain accountable to Parliament for NHS expenditure.

“We welcome the acknowledgement of the critical role played by GPs within the NHS and the clear signal that changes are needed to improve the quality of general practice. If, as expected, these changes include transferring budgets to GPs, it will be important to learn from the previous experiences of GP-led commissioning in the United Kingdom and other countries to ensure it delivers benefits for patients and efficiency savings across the health system while ensuring accountability for public expenditure.”

But analysts have warned of the dangers of giving financial accountability to clinicians. Dean Arnold, Head of Healthcare Practice at Deloitte, said: “Putting patients first is always a positive thing to do, so too is empowering clinicians. However, this requires some caution as clinicians are not specialists in cost management – a skill that will become increasingly important. With power comes greater accountability. Patients should be able to hold clinicians to account. It can be argued that today healthcare managers and executives are far more accountable to patients than clinicians. It will be vital to get the right ‘checks and balances’ if we are to put the NHS in the hands of clinicians.”

Coalition health team

The Government’s new Health Ministers and their portfolios are as follows:

Minister of State for Health – Simon Burns

Responsible for: Legislation, NHS Performance, Health Services, Reconfiguration of Services, Patient Safety, Application of Quality Regulation and Connecting for Health.

Minister of State for Care Services – Paul Burstow

Responsible for: Long Term Care Reform, Carers, Personal Health Budgets, Safeguarding Vulnerable Adults, End of Life Care, Long Term Conditions (including cancer and diabetes), Dementia, Physical Disabilities and Learning Disabilities.

Parliamentary Under Secretary of State for Public Health – Anne Milton

Responsible for: Public Health, Blood and Transplants, Fertility and Embryology, Children’s Health, Maternity Services and Nursing and Midwifery.

Parliamentary Under Secretary of State for Quality – Earl Howe

Responsible for: NHS Constitution, NHS Commissioning Reform, Primary Care, NICE, R&D, Finance, Innovation and Medicines, Pharmacy and Industry.