Key facts: Health and Social Care Bill
It seems the Government has taken on board many made by the NHS Future Forum, for the recent set of Health Bill discussed in Parliament this week reinforces the NHS constitution, gives patients real control over their care and, thanks to more emphasis on self-care, increases the input of pharmacy.
Who is in charge?
The Government has confirmed the Secretary of State for Health as being ultimately accountable through a multi-year, rolling mandate to the NHS Commissioning Board.
Clinical commissioning groups
Rather than GP commissioning groups, consortia have become clinical commissioning groups (CCGs) to reflect patients’ and health professionals’ wider inputs. CCGs will remain within local authority boundaries agreed by the national commissioning board unless they can show that crossing these would benefit patients. They will be responsible for every person within their boundaries, not only those registered by their constituent practices.
In turn, the commissioning board will have to consult with health and wellbeing boards before authorising a CCG. Each CCG will include at least two lay members, one registered nurse and one specialist secondary care doctor, none of whom can be employed by any provider to the group.
Minutes and details of contracts must be made public, with groups held accountable for keeping their governance in line with Nolan principles, and having a statutory responsibility to make their own commissioning decisions.
The quality premium
The Government has revised its approach to incentive payments to reward effective commissioning. Strict rules will cover how quality payments can be made or withheld, and how CCGs can spend them.
Commissioning Board’s role
As well as its responsibilities outlined above, the NCB’s role will include: commissioning on behalf of shadow groups after April 2013; consulting with Monitor on how to apply competition and choice to services; and exploring new ways to integrate care. The NCB will be accountable for CCGs until it grants them authorisation.
What about sharing clinical knowledge?
Clinical networks will be expanded and clinical senates established, both hosted by the commissioning board, to give a wider voice to health care specialists and with close links to professional bodies and royal colleges. Although clinical senates are established at an NCB level, at the CCG level, before they are authorised, they will have to show evidence of engagement with the clinical senate.
Choice and competition
Promoting choice has always been part of the NHS constitution, and the Government has strengthened choice in the Bill, and has prioritised the mandate to the commissioning board to extend personal health budgets, including integrated budgets across health and social care.
The amended Bill places a new obligation on service providers to make their operations and mistakes more transparent. It also directs foundation trusts to hold board meetings in public and, in a move which goes beyond what the Future Forum recommended, requires them to show separate accounts for NHS and private-funded services.
How does this benefit the public?
Health and wellbeing boards, and Monitor, will have a new duty to involve users and the public; the duties of the commissioning board and CCGs to involve patients, carers and the public will also be clarified. The Government has also made clearer patients’ rights in a number of areas of the Bill, including their right to receive drugs and treatments recommended by the National Institute for Health and Clinical Excellence and their right to confidentiality.
Education and research
Although the Government made little mention of education and training reforms, and has still not responded to the Future Forum’s recommendation that Health Education England be established soon, it says it will continue to work on this area and release more details in the autumn. However, the Secretary of State now has a duty, along with CCGs, to promote research, with the Government calling for a culture of research to be embedded for the commissioning board and Public Health England.
What’s the timescale?
The Bill — originally expected to gain royal assent in late 2011 — is unlikely to reach the statute book until early 2012. Nevertheless, the commissioning board will be established by October 2012 to start to authorise CCGs. There will be some flexibility in the implementation timetable, with the board taking on the responsibilities for CCGs that are not ready to do so themselves from April 2013. At the same time the board will develop CCGs’ capability to take full responsibility for commissioning over time.
Primary care trusts (PCTs) will continue until 2013 — when their clusters will be reflected in the commissioning board structure — as will the 10 strategic health authorities. The deadline for all NHS trusts to become foundation trusts by April 2014 has been eased in favour of all trusts making that transition when “clinically feasible”. Remaining an NHS trust will not be an option but the Bill will not include a deadline.
So is this an improvement?
Ash Soni, the pharmacist on the NHS Future Forum panel, sees the amendments as positive for pharmacy. He says: “No doors have been closed to pharmacists; in fact, some have been pushed open a bit more. It’s a chance to work around integration, for pharmacy to show how it fits within the care pathway. Overall, what pharmacy has got out of these amendments has been more opportunity.
“It is now up to the profession to make the most of this. We’ve got 18 months until the first consortia come on stream in 2013 so we must continue to demonstrate how not engaging pharmacy would make consortia not fit for purpose, but we’ve got to continue to shout loudly; we can’t just wait to be invited. Members of the professiion must put themselves forward to engage with CCGs and health and wellbeing boards and be willing to become members of these new structures. ”
The Third Reading of the Bill was about to take place as The Journal went to press.
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