The Health and Social Care Bill has barely been out of the press since its first reading on 19 January 2011. On 6 April 2011 the Government launched a "listening exercise" on how the Bill might be improved, which was due to report at the end of May. The NHS Future Forum was employed to oversee this exercise.

The NHS Future Forum is a group of clinicians, patient representatives, voluntary sector representatives and others from the health field, including frontline staff, led by Professor Steve Field. It is intended to drive the process of engagement with staff, patients and communities and will continue to serve this purpose after the listening exercise.

Given the resounding opposition from many at the frontline of health in relation to this controversial Bill, we have awaited the recommendations with interest to see whether they amount to a quick polish or a complete overhaul.

The wait is over…

The Forum reported today, 13 June 2011, to the Prime Minister, Deputy Prime Minister and the Secretary of State for Health on what they have heard on the following four themes:

  • the role of choice and competition for improving quality; 
  • how to ensure public accountability and patient involvement in the new system; 
  • how new arrangements for education and training can support the modernisation process; and 
  • how advice from across a range of healthcare professions can improve patient care.

The report has had a mixed reception with some seeing the recommendations as unrealistic and unclear, while others commended the Forum for getting to the point on competition and private providers.

The recommendations

On the basis of the listening exercise the Forum made 16 key recommendations, including: 

  • the speed of the proposed changes should be varied so that the NHS implements them only where it is ready to do so, while commissioning consortia should only take on a full range of responsibilities when they can demonstrate they are capable of so doing; 
  • the Secretary of State for Health should remain ultimately accountable for the NHS, but the NHS should be freed from day-to-day political interference; 
  • nurses, specialist doctors and other healthcare professionals, as well as GPs, should be involved in making local decisions about the commissioning of care;
  • competition should be used as a tool to secure greater choice and better value for patients – it should be used not as an end in itself, but to improve quality, promote integration and increase citizens’ rights;
  • Monitor’s duty to ‘promote’ competition should be removed and the Bill amended to require Monitor to support choice, collaboration and integration; 
  • further drive for change in the NHS should not be based on competition, but on citizens’ power to challenge the local health service when they feel it does not offer meaningful choices or good quality; 
  • private providers should not be allowed to 'cherry pick' patients and the Government should not seek to increase the role of the private sector as an end itself; 
  • Health and Wellbeing Boards should become the generators of health and social care integration, and the boundaries of commissioning consortia should not normally cross those of local authorities; 
  • as the NHS belongs to the people, all organisations spending NHS money should be subject to the same high standards of public openness and accountability.

The Forum’s recommendations will now be considered by the Government and their response issued tomorrow.

What does this mean in practice?

These recommendations have real implications for those providing health services if they are implemented; however at this stage, we are left with more questions than answers.  Will commissioning consortia be required to include specialist doctors, nurses and other healthcare professionals as members under their constitutions? How will consortia be deemed “ready” to take on their full range of responsibilities?  Also, we are still no clearer as to what will happen to the NHS estate.

Although the recommendations would significantly water down the Health and Social Care Bill regarding competition and Monitor's role, it is still clear that the landscape of the NHS is changing. The emphasis is now on moving away from the rhetoric of competition to a landscape based on collaboration, particularly between health providers and local authorities. 

There is a desire for the NHS to be independent from politics, but given that the NHS is such a big political issue, how this will be achieved whilst ensuring accountability remains is unclear.

One of the overwhelming themes of the Bill has been that it has all happened in a rush … this is clear from the NHS Future Forum Report which explains the need for time. However, as acknowledged by Professor Steve Field, the uncertainty that this Bill has created has left the NHS feeling paralysed and unable to move forward. This uncertainty has also led to talented management and staff leaving the NHS, which is an organisational risk in itself. If a lack of clarity remains following the Government’s response (due tomorrow), it is difficult to see how NHS organisations can stem the tide.

How can we help?

Our commercial team has a breadth and depth of health law experience and has helped health bodies through several NHS restructures. We would be happy to provide you with a more detailed summary of what the announcements may mean for you or discuss how you can best prepare for the changes ahead.

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