Last month saw the publication of the NHS Future Forum report and the Government's rapid acceptance following the listening exercise on the Government's Health and Social Care Bill. Many in the NHS will be happy to have some clarity on the future, if nothing else. The Forum has done a good job of helping to clarify and suggest ways that the best intentions and vision of the original legislation can be built upon, whether in terms of creating more patient choice or establishing the conditions for less political interference and increased clinical leadership. The report points to valid concerns, which need to be addressed. For example, the recommendation that ”competition should be used as a tool for supporting choice, promoting integration and improving quality” and that Monitor's role in this respect should be diluted.
As well as providing a greater emphasis on integration and co-ordination of services and a lesser emphasis on pure competition, the Future Forum suggested a move towards clinical commissioning and a slower pace to the changes.
Below are some of the key points to emerge from the Forum’s report:
- Secretary of State retains and is accountable for the overall responsibility;
- strengthening the governance of the clinical commissioning groups (note change of title from GP commissioning consortia);
- widening the clinical input to commissioning;
- introducing flexibility in the implementation timetable;
- expecting clinical commissioning groups to work very closely with health and well-being boards;
- removing Monitor's duty to promote competition and replacing it with a core duty to protect and promote patients’ interests and also to promote integration;
- setting out plans to publish details of the transition to the new education and training system; and
- recognising explicitly that good management is essential.
But health thinkers have made it clear that Government now needs to move on and create a robust framework which will allow the reforms to flourish. Further uncertainty would only cause more difficulties for managers and clinicians, whilst delaying the drive for efficiency savings.
These recommendations have real implications for those providing health services if they are implemented. The question is whether the Government’s proposed amendments to the Bill will speak fully to the Forum’s recommendations. However at this stage, much of the detail of how they would work in practice remains unclear; there is an urgent need to move beyond policy debates to practical implementation on the ground as the real challenges for the NHS remain. These are delivering £20 billion of efficiencies over four years and addressing services being fragmented for too many patients. The cost of the NHS is growing much faster than the economy that pays for it. Mathematics alone say that this can't go on forever!