Lansley's plans

The Coalition has published its response to the consultation on its White Paper, heremade a few random announcements and set out the details for next years funding allocations.
They are refusing to admit they have broken the pledges not to undertake any top down reorganisations, and they are actually reducing funding in real terms not increasing it.
There is some evidence that they have listened to some of the responses but the core principles of moving commissioning to GP Consortia, making all (NHS) providers Foundation Trusts, making competition and market regulation the driving force and ending top down management. They now accept the need to “pilot” some of the new arrangements and shadow consortia and shadow Health & Wellbeing Boards will be set up.
They simply ignored the Local Government’s assertion they were in a better position to commission many services (children, mental health, learning disability, long term conditions etc) than GP Consortia. They have reprieved scrutiny but left the details up to each local authority. The Health & Wellbeing Boards have further but vague responsibilities but no actual levers to pull to make things happen.
They have eased the target for reduction in management, instructed consortia to use PCT staff to avoid redundancy costs and added an extra year to the period in which they have to achieve the £20bn cost reduction.
The drive for social enterprise goes on now with the idea that staff can convert their foundation trust in a staff owned social enterprise (Right to Provide). They appear to be extending the Right to Request (?) which applies to primary care providers. Monitors powers to interfere in trusts will be removed, but a bit later than planned. They think 20 trusts will not make FT status and they have set up some nasty support for them.
There continues to be much stress on the need to promote competition as opposed to using it when appropriate. Some more dangerous announcements are the ending of the requirement for Trusts to abide by national terms and conditions of employment, ending the fixed price tariff and allowing competition based on price and removing the cap on the private income of foundation trusts. Monitor and the National Commissioning Board now have to jointly agree prices and pricing structures. Monitor taking over social care pricing is to be delayed.
Our headlines would be end of the NHS as we know it to go ahead. Making all trusts foundation trusts with greater freedoms, holding their assets in an offshoot of the DH, and giving commissioning to quangos effectively privatises the NHS.
The headlines according to them are:-
• significantly strengthen the role of health and wellbeing boards in local authorities, and enhance joint working arrangements through a new responsibility to develop a “joint health and wellbeing strategy” spanning the NHS, social care, public health and potentially other local services. Local authority and NHS commissioners will be required to have regard to this;
• create a clearer, more phased approach to the introduction of GP commissioning, by setting up a programme of GP consortia pathfinders. This will allow those groups of GP practices that are ready, to start exploring the issues and will enable learning to be spread more rapidly;
• accelerate the introduction of health and wellbeing boards through a new programme of early implementers;
• create a more distinct identity for HealthWatch England, led by a statutory committee within the Care Quality Commission (CQC);
• increase transparency in commissioning by requiring all GP consortia to have a published constitution;
• change our proposal that maternity services should be commissioned by the NHS Commissioning Board. This reflects the weight of consultation responses arguing that, in order to focus on local needs, maternity services should be the responsibility of GP consortia, backed by national support to secure improvements in quality and choice;
• recognise that our original proposal to merge local authorities’ scrutiny functions into the health and wellbeing board was flawed. Instead we will extend councils’ formal scrutiny powers to cover all NHS-funded services, and will give local authorities greater freedom in how these are exercised;
• phase the timetable for giving local authorities responsibility for commissioning NHS complaints advocacy services, and allow flexibility to commission from other organisations as well as from local HealthWatch;
• give GP consortia a stronger role in supporting the NHS Commissioning Board to drive up quality in primary care;
• create an explicit duty, for the first time, for all arm’s-length bodies to co-operate in carrying out their functions, backed by a new mechanism for resolving disputes without the Secretary of State having to act as arbiter. In particular, Monitor and the NHS Commissioning Board will have to work jointly in setting prices, rather than have Monitor decide and the Board able to appeal.

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