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Review calls for “substantial” changes to health reforms

Doctors urge government to act quickly on recommendations

Caroline White

Tuesday, 14 June 2011

Commissioning must not be the sole responsibility of GPs, and clinicians must be prepared to make difficult choices and decommission some services and hospitals for the benefit of patient care, says the NHS listening exercise review.

Doctors’ and nurses’ leaders have given a cautious welcome to the recommendations, but now want the government to act quickly to set up the infrastructure to support change.

The report from the Future Forum, headed up by GP professor Steve Field, is based on the views of 6700 patients, healthcare professionals and members of the public attending 6700 “listening” events; 3000 comments; 25,000 emails; and 600 detailed questionnaires.

It focused on four core areas: choice and competition; patient involvement and public accountability; clinical advice and leadership; and education and training.

Among the raft of recommendations it makes, the review says that GPs “cannot and should not” commission services on their own, and that they must be required to “obtain all relevant multi-professional advice to inform commissioning decisions and the redesign of patient pathways.”

Difficult decisions about the location of services must be made, but these should be clinically led, it says, adding that there has been far too much focus on different parts of the system, and far too little on how all these will be joined up to provide the integrated care that patients need.

In respect of competition—one of the most hotly contested areas of the reforms— the review states: “The place of competition should be used as a tool for supporting choice, promoting integration and improving quality. It should never be pursued as an end in itself.”

And it goes on to recommend that Monitor’s role in relation to “promoting” compettion should be “significantly diluted.”

It also calls for more time to be given to the education and training of the healthcare workforce, warning: “The effects of mistakes made now will be felt for a generation.”

In his foreword to the review, in the form of a letter to David Cameron, Nick Clegg and health secretary Andrew Lansley, professor Field acknowledges that the NHS has to change in order to keep pace with technological/scientific and demographic changes. The taxpayer cannot be expected to keep forking out for spiralling costs, he says.

And he takes the government to task for failing to explain clearly how the structural and technical details of the Health and Social Care Bill would help the NHS improve.

Other key recommendations:

  • Values of NHS Constitution should be legally protected
  • Secretary of State must remain accountable for the NHS
  •  “No decision about me without me” to be translated into legal duties
  • Statutory duty for transparency about how public money is spent
  • Retention of experienced managers
  • NHS Commissioning board to commission for consortia not ready by 2013
  • No cherry picking for private providers; an no increase in private providers as an end in itself
  • Strengthen role of health and wellbeing boards
  • Local authority and commissioning borders to match
  • Keep postgraduate deaneries
  • Public Health England separate from Department of Health to ensure independence
  • Set up NHS Commissioning Board as soon as possible

Commenting on the report, chair of BMA Council, Dr Hamish Meldrum said the review had addressed many of the BMA’s key concerns.” We are hopeful that our ‘missing’ concerns, such as the excessive power of the NHS Commissioning Board over consortia and the so called ‘quality premium’ will be addressed as more detail emerges.

While we welcome the acknowledgement that the education and training reforms need much more thinking through, there needs to be immediate action to prevent the imminent implosion of deaneries.”

RCGP Chair Dr Clare Gerada said the College still had some concerns. “We need the government to reassure us that GPs will be given the freedom and autonomy to lead the decision-making and design of future integrated health systems drawing on the support of other health, social care and third sector services. We support clinician-led commissioning but continue to believe that GPs are best placed to lead this process.”

The Royal College of Nursing’s Chief Executive & General Secretary, Dr Peter Carter, said “It is disappointing that the Future Forum appears not to have accepted the view of thousands of our members, who are calling for a mandatory requirement for nurses to sit on the board of every commissioning consortium.”

The Royal College of Physicians president Sir Richard Thompson added: "We urge the government to grasp the opportunity to give hospital doctors a mandated place on the board of local commissioning bodies to guarantee integration of primary and secondary care.”

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