The Health and Social Care Bill 2011 (the Bill), intended to modernise the NHS, was published by the Department of Health on 19 January. The Bill includes proposals to:
- abolish England's 151 Primary Care Trusts (PCTs) and 10 Strategic Health Authorities;
- bring commissioning closer to patients by giving responsibility to GP-led commissioning consortia;
- increase accountability for patients and the public by establishing ‘HealthWatch’, local health and wellbeing boards within local councils;
- liberate the NHS from political micro-management by supporting all trusts to become foundation trusts and establishing independent regulation; and
- reduce bureaucracy by streamlining arm's-length bodies.
The thrust of the Bill is to improve patient care by increasing patient choice and involvement in decisions about their treatment; with clinicians leading the way based on what they consider their local patients need.
Abolition of PCTs
PCTs will be abolished and it is envisaged their functions will be transferred to GP consortia.
The Bill requires all GPs to form a commissioning consortium to provide primary medical services to a designated area. Every consortium will be required to prepare a plan at the beginning of each year, setting out how it intends to meet health and financial targets. The consortia must also prove they have consulted with their patients.
NHS Commissioning Board
The Bill creates the NHS Commissioning Board which will be granted wide-ranging powers to help determine the structure and shape of GP consortia, including powers to:
- intervene if consortia have ‘failed to discharge any of their functions’ or if ‘there is a significant risk that a commissioning consortium will fail to do so’;
- intervene to change the size of a consortium or the way it delivers its medical services or remove any member of the consortium's management, if it is found to be failing;
- make payments at the end of each financial year to consortia which ‘perform well’, by either improving health outcomes or saving money; and
- withhold money at the end of the year if advanced payments are made but consortia fail to hit their targets.
Foundation Trust status extended
NHS Trusts are to be abolished and all Trusts are to attain Foundation Trust status having greater financial freedom. The Bill also envisages Foundation Trusts becoming insolvent. It is anticipated “health special administration orders” will be made by the courts where a Foundation Trust becomes insolvent with the “affairs, business and property” of Foundation Trusts being transferred to other health service bodies.
We anticipate the mechanism for insolvency being created but it will be a brave Secretary of State for Health who allows a Foundation Trust to go “bust” with the impact this will have on a local community. Whether in reality and, in particular, in the current political climate a Foundation Trust will be allowed to become insolvent will have to be seen.
HealthWatch England Committee
The Care Quality Commission is to appoint a committee (the HealthWatch Committee) to provide the Commission with advice as to the views of health and social service users on their needs for and experience of health and social care services.
Each local authority is to create a local HealthWatch organisation to provide advice and information on access to local care services and reporting to the HealthWatch England Committee of the Care Quality Commission.
We await with interest as to how this will work in practice and whether the HealthWatch Committee will be able to respond in a positive way to the local communities’ views.
The impact of change
Concern has already been expressed by The National Audit Office that the proposed reforms to the NHS will raise costs in the short term and could lead to a decline in the quality of services. The purpose of the proposed reforms are to improve the quality of healthcare, reduce bureaucracy and provide autonomy to GPs who are closer to the patient and have a greater understanding of their medical needs. It is also envisaged there will be long term savings to the NHS budget.
We watch in anticipation as the Bill proceeds through the Houses of Parliament.
The Bill is available to view in full here.