The coalition government has announced the publication of the first draft for the ‘Health and Social Care Bill 2010-11’, detailing potential large-scale reforms to the NHS in England.
The Department of Health (DH) has said the Bill, which follows the White Paper ‘Equity and Excellence: Liberating the NHS‘, will improve the NHS in several key ways, including involving patients more in the decision making process and measuring success by more meaningful outcome.
Letting clinicians lead the way in decision-making will also play a large part in improving NHS care according to the DH, with plans to get rid of the 152 Primary Care Trusts (PCT) in England as well as the nation’s 10 Strategic Health Authorities (SHA).
Responsibility for budgeting and commissioning, currently done by the PCTs, will be passed onto newly formed GP consortia by 2013.
The DH said the Bill will save the NHS over £5bn by 2014/15 and then £1.7bn each year after.
The Bill also confirms the creation of Public Health England to improve the nation’s public health, as well as plans to streamline several health-related bodies, including the National Institute for Health and Clinical Excellence (NICE), and to establish the new agency HealthWatch, previously described as a “‘citizen’s advice bureau’ for health and social care”.
Commenting on the launch of the Bill, Andrew Lansley, Secretary of State for Health, said: “Modernising the NHS is a necessity, not an option. In order to meet rising needs in the future, we need to make changes now. We need to take steps to improve health outcomes, bringing them up to the standards of the best international healthcare systems, and to bring down the NHS money spent on bureaucracy.”
“This legislation will deliver changes that will improve outcomes for patients and save the NHS £1.7bn every year – money that will be reinvested into services for patients.”
Several leading organisations have already responded to the bill, with many re-stating concerns made during the preceding White Paper’s consultation period over the speed, timing, scale and financial cost of the proposed reforms.
The Royal College of General Practitioners (RCGP) said: “The College is concerned that some of the types of choice outlined in the government’s proposals run a risk of destabilising the NHS and causing long-term harm to patient outcomes, particularly in cases of children with disabilities, those with multiple co-morbidities and the frail and elderly.
“While the government has sought to reassure us, we have yet to be presented with sufficient evidence to underpin these reassurances. We look forward to reading the detail in the Bill and having further dialogue with the government about this.”
Chief executive and general secretary for the Royal College of Nursing, Dr Peter Carter, said: “This seminal bill has the potential to transform the NHS, however, at the same time as the service is being tasked with saving £20bn, we are concerned that the proposed reforms are too much too soon.”
The British Medical Association (BMA) also voiced its worries: “The BMA supports greater involvement of clinicians in planning and shaping NHS services, but the benefits that clinician-led commissioning can bring are threatened by other parts of the Bill. In particular, the legislation will allow competition to be forced on commissioners, even when they believe the best and most appropriate services can be provided by local hospitals.”
The Royal College of Psychiatrists said it was particularly worried about the effects on opening up the commissioning of services: “There is a danger that, in the new system, services will go to the cheapest provider at the expense of quality. There is also a danger that, if a multiplicity of providers are delivering different aspects of care, that care may be fragmented and patients may fall between gaps in services.”
Unions were also critical of proposals made in the Bill, with key concerns from UNISON, the UK’s largest union, including the rise of postcode lotteries for healthcare; NHS services being opened to EU competition law; and the advent of price competition and its effect on patient care.
Karen Jennings, UNISON head of health commented: “It is time to turn up the heat on the public debate. These changes are undemocratic, they were not in any party manifesto and no one has been given the chance to vote on them. The NHS is a service that many take for granted now, but will not be able to in the future. As more private companies pile in to grab their share of the £80bn in taxpayers’ money the NHS will change from a publically run and accountable service, into a conglomerate of competing private companies outbidding the NHS for patients.”
Despite the grievances, changes to England’s healthcare services are already being enacted. Pilots for GP commissioning have been put into place in certain parts of the country, with the Department of Health reporting that 141 groups of pathfinder GP practices are already in place.
The Nuffield Trust, an independent health policy charitable trust in the UK, however has warned that considerable investment must be placed in the management and IT use within such consortia to achieve successful outcomes after a report into similar groups in the US.
The DH has further information on the Health and Social Care Bill 2010-11.
Parliament has more information on the remaining stages the Bill has to go through before being implemented.