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“2020health is an important and thoughtful contributor to the health debate”

Dr Sarah Wollaston MP, Chairman, Health Select Committee

 
 

2020health response 2020health White Paper Response

2020health issues a response to the recent Government White Paper, 'Equity and Excellance: Liberating the NHS' and its subsequent consultations.

Summary of 2020health response

 

On commissioning

  • The White Paper places great emphasis on the notion of commissioning, but seems to fail to recognise the distinctions of its different forms.
  • The parts of the commissioning cycle that require needs assessment can only be accurate, if carried out by organisations that cover large population groups, the precise size being dependent on the service being commissioned.
  • The mechanical aspects of service procurement that cover the assessment of potential supply (and its modification) at an operational level, and the management of the supply of and demand for services, both need organisations that are more grounded in ‘real life’ and have operational credibility.
  • GP Commissioning has its risks. Linking ownership of both responsibility and resources, encourages us to make measured and prudent decisions. However, if the scale of attachment is inappropriate, then notions of responsibility diminish. If ‘decision latitude’ does not match the span of control, inappropriate actions ensue, with a lack of accountability and probity.
  • GPs ideally situated in NHS to carry out direct procurement for individual patients. Practices could work together to gain economies of management scale and increased purchasing power when dealing with hospital providers.
  • There are risks associated with dismantling all the tiers of the NHS between Whitehall and the local GP commissioning groups; Therefore 2020health would suggest a skeletal intermediate tier.
  • More scrutiny is required regarding accountability and governance arrangements in the new system.

On transparency of outcomes

  • In the push towards better outcomes, we agree that the NICE quality standards will be useful in driving high quality care for specific diseases. However for this approach to be effective, it is essential that the quality standards should be ambitious, setting the aims for care above what is currently achievable, in order to drive innovation in each field. The quality standards should be a challenge for healthcare providers to aspire to achieve.
  • In addition to the NICE quality standards it would be helpful if a channel was created for healthcare providers and commissioners from different areas of the country to be able to share their learning and the means that they have managed to achieve quality. This could take the form of an interactive website, or regular meetings, or teleconferencing on particular topics and disease areas.
  • We believe that in order to improve health outcomes as well as patient satisfaction, a greater emphasis needs to be placed on the mental health of those that are physically ill. This may be achieved through giving patients greater control of their own care, and enhanced through local support networks. Telehealth technology in the home has also been shown to lead to a greater confidence amongst those with long term conditions, allowing them to manage their own care more effectively.

On regulating healthcare providers

  • 2020health agrees that all NHS organisations should be able to benefit from the lifting of the cap on private income providing that this does not detract from its primary duty to provide high quality care with equality of access for all.
  • Given that financial stability and service provision are key, it is essential that Boards demonstrate competence to provide good management before undertaking mergers.
  • The current proposals appear to retain some of the overlap between Monitor and the CQC. Consideration could be given to provision of one regulatory body with the ability to license both health and social care providers.
  • In regulating or restricting Trusts activities Monitor will need to take into consideration some organisations responsibilities to wider communities especially in the provision of specialist services or regional services.

On Arms Length Bodies

  • 2020health note that it is an incongruous dynamic, where health quangos becomes tightly centralised while NHS Trusts are almost entirely devolved FTs. FTs are given the freedom in order to maximise commercial opportunities, where conversely quangos are supposed to optimise commercialisation without the same level of freedom.
  • Significant savings are symbolic only if the majority of staffing costs are transferred from one public sector agency to another. Proposals need to make clear where there is opportunity to share programmes, staff resources and functions.
  • 2020health also realise that the review raises several opportunities including a dedication to simplifying organisation’s remit, limiting overlap and information duplication. There is also tangible opportunity in having a new public health service. With this there is the added benefit of clarifying regulatory responsibility and therefore transparency.

The role of IT in supporting the delivery of the NHS White Paper

  • Repeatable, scalable processes that handle and transfer information, and that can enable seamless communication and collaboration, will be fundamental to the vision of the NHS White Paper.
  • Both local and nation information strategies cannot be isolated from management, clinical, process and organisational change – all evidence points to failure when this is the case - and must be seen as a core element in the plans to transform the NHS, not as an after-thought or peripheral activity.
  • To maintain the relevance of IT in the NHS, a formalised process is required that ensures that the implications for and of IT is recognised in the policy development process of the Department of Health, and in those bodies in the future designing changes to the way health and care are provisioned. In this regard, NHS information strategy should be formally linked to NHS business strategy, driven by the policy agenda.

On HealthWatch (HW) and Health and Wellbeing Boards (HWBs)

  • The function of HealthWatch (HW) should be both advocacy and information resource. They won’t have knowledge to do strategic overview but should contribute to the Director of Public Health’s information gathering.
  • If HW is to inform choice, then this needs to be about treatment options much more than the practitioner, so to make this work there needs to be a robust and extensive source of patient information – which doesn’t currently exist.
  • Health and Oversight Scrutiny Committees (HOSC) evaluate health and social care delivery but this ability would be compromised if they were also involved in providing services, which with the convergence of health and social care will be the case for HWBs. HWBs should, like GP Consortia Boards, act as the commissioning hub for social services so there is a balanced approach between health and social care services. The H&W departments should also be where the activity on local health improvement and the public health function reside.
  • There remains a question about evaluation of Local Authorities to ensure that they are resourcing HWBs and HW properly.