Understanding the NHS reforms Jo Webber, Deputy Policy Director 20 th March 2012.

Understanding the NHS reformsJo Webber, Deputy Policy Director

20th March 2012

What will be covered?

• What was the system like before the reforms?• Summary and analysis of reforms to date• What will it be like going forward?

Current structure of NHS in England

Current challenges facing the NHS (1)

Demand pressures• Rising expectations• Demography• Changing patterns of disease e.g. survival from cancer

and other illnesses/ conditions• Impact of lifestyle behaviours on health• Increasing costs associated with new treatments & drugs

Current challenges facing the NHS (2)

Drive to improve quality and outcomes• Pockets of poor-quality care and patient experience• Poor co-ordination of carePressure on public finances• Drive to reduce public sector borrowing requirement• Growth limited to 0.1% above general rate of inflation• Need to achieve £20bn productivity gains by 2015Disconnect between health and social care• Local authority responsibility with similar financial

pressures• Long term funding issues for social care

Current challenges facing the NHS (3)

Need to improve efficiency/ reduce costs• Moving care closer to home • Improving co-ordination of networked services• Making integration a realityNeed to adapt current patterns of service provision• Closure/reconfiguration of some unsustainable

services • Over-capacity of some types of provision in some

areas

NHS Reforms: a brief overview

• Early priority for Conservative/ Liberal coalition government :• White paper with main proposals published July ’10• Bill introduced to Parliament 11 January, 2011• Considerable opposition – political and from

professions• Parliamentary process “paused” April, 2011 for

further discussions and proposals amended• Still going through Parliament

• Some structural change happening in advance of final legislation e.g. changes to PCTs and SHAs

Objectives of NHS Reforms

Key themes•Patients/public at the centre of the NHS •Focus on quality and improving outcomes•Empowering health professionals, particularly general practitioners to

lead commissioning

Also• Shift from NHS as commissioner/provider to NHS as funder of care • Greater plurality of provision and more competitive market-place• Emphasis on local planning and decision making• Focus on improving accountability of the NHS• Shift of responsibility for public health to local authorities

Key elements of reformsMajor structural reforms• Abolition of Strategic Health Authorities and PCTs by 2013• Shift of some DH responsibilities to new NHS Commissioning Board• Transfer of main commissioning responsibilities to new local clinical

commissioning groups (CCGs)• Transfer of responsibility and budget for public health to local authorities• Creation of local health and wellbeing boardsIncreased competition and choice• NHS provision opened up to competition• New sector regulator • Expectation all provider trusts become foundation trusts by 2014Focus on outcomes: • Outcome frameworks for NHS, public health, social care and

commissioning

Key concerns about the reforms (1)

Competition:• Privatisation of provision• Fragmented services/ undermining integration

New commissioning arrangements:• Complexity/ split responsibilities• Capacity and capability of local clinical commissioning consortia• Privatisation of commissioning: commissioning support organisations• Health and wellbeing boards underpowered

Some existing NHS providers will struggle to achieve FT status:•Mergers and acquisitions will be needed

Key concerns about the reforms (2)

Clarity on some of the detail still needed:• Commissioning responsibilities• Roles and responsibilities for quality• Defining essential services and how they should be protected

Accountability for decision-making:• Inadequate and insufficiently democratic

Do not address the main challenges facing the NHS• Financial challenge of delivering £20bn productivity gains by

2015

Disruption associated with reforms

Will they work?• Focus on increased clinical input to commissioning and

outcomes welcome• Clinical support vital to make the reforms work:

• Develop clinical commissioning capacity• Secure GP buy-in to drive clinical commissioning

• Building effective partnerships and relationships key:• Nationally between regulators and the Commissioning Board • Locally: across NHS providers; NHS and local government; & health

and social care (providers and commissioners)• Difficult decisions will be needed to secure NHS sustainability• Are the right incentives in place?