Health and Social Care Bill July - August 2011

The cost of the government's plans to restructure the NHS is rising at almost £1m a day - http://www.guardian.co.uk/society/2011/jul/28/cost-nhs-changes-rising

The Bill finished its second committee stage before the recess, with the Coalition using its majority to get its amendments through.  It will return to the Commons on 6th September for report with a vote on 7th September and then be passed through to the Lords.

Meanwhile Andrew Lansley published the government's first response http://www.dh.gov.uk/en/Consultations/Responsestoconsultations/DH_125442 .
This document instructs PCTs to consult about "extending choice" for 8 services, of which each PCT is to choose 3.  This is to be done during September/October.  Details of this instruction are in the operational guidance - http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_128462.pdf

The Bill is not a done deal and Evan Harris, a doctor and former Lib Dem MP who led the opposition at the Lib Dem Conference, says that despite concessions in the small print, the core privatisation principle remains.  Let's hope the Lib Dems can still be persuaded to vote against it - not to mention the Lords.  Pressure on MPs and peers must be maintained.  The Bill can still be defeated in the Commons if all the opposition MPs vote against it.

38 degrees now have funding to examine the legal issues in much more detail and will be reporting on this soon.

NHS Sheffield responses to questions put at the 5th July Public Meeting

NHS Sheffield offers the public the opportunity to ask questions of the Board at its public meetings.  To celebrate the 63rd birthday of the NHS we posed three sets of questions particularly around what the NHS might look like in 2013 when it reaches 65.  The Chair of the PCT was anxious to assure us that they were working hard to ensure that they achieve the best handover possible.

 

The PCT meeting itself was a long one because of the care homes issue so we only got to ask verbally the first of our questions about the reforms - but we were assured we will get written answers to the questions about patient involvement and privatisation and we had brief but friendly conversations with some PCT directors before the private part of their meeting began.  

The question we did ask centered around what the local NHS structure might look like under the amended Bill (part of the question about additional costs will be answered separately as well). 

 

As had been said earlier in the meeting, the situation changes week by week if not day by day and David Nicholson, the head of the NHS, will be making a key speech on Friday.  Some of the national information plus a minor leak is at http://www.guardian.co.uk/society/2011/jul/05/leaked-paper-nhs-commissioning-board

 

We were told that the government does appear to have rowed back from its original intention to place the support organanisations for commissioning into a market.  The Guardian article above refers to quite a large NHS commissioning Board at national level, with, presumably, local outposts.  As of this week there will now be four Strategic Health Authorities (divisions not yet decided) plus, I think, London. To these will report a number of PCT clusters  but these will not necessarily by the same as the ones which have just been developed (ours is currently South Yorks + Bassetlaw).  The clusters will have clinical commissioning groups , one for each local authority area (to fit in with the new health and wellbeing boards) and GP consortia will be represented on these - along with the other reps added under the Bill amendments.  Associated somehow with these groups will be the specialised regional networks (like the cancer network) which Lansley originally wanted to abolish.  Also somehow associated will be the amendments' new construction of a 'clinical senate'.

 

Commissioning will be supported by a Community Support Services organisation with Community Support Units covering populations of around 1.5 - 2 million (? the size of a cluster?).  The government's original intention was to put this out to tender but it now seems possible that this will not happen and the new organisations seem likely to be formed out of existing staff (for my comment see below.)  

 

The 4 current consortia in Sheffield will work together and possibly move to forming one organisation but with a strong local service focus.  Although GPs will have the key involvement in commissioning, fewer of them will actually be involved directly than seemed likely under the original Bill.  More GPs in Sheffield are interested than there will be places, but others are getting put off as the bureaucratic implications become clearer. 

 

The issue of the transfer of public health to local government etc awaits further pronouncement later this month. 

 

The Bill's intention is that Clinical Commissioning Groups, once approved for competence by the National Commissioning Board, will be legal entities beginning from April 2013 when the PCTs will be abolished if the Bill becomes law.  The National Commissioning Board itself will be established as a Special Health Authority in October this year.  Clincial Commissioning groups will act as committees of the PCT Cluster Boards and operate as 'shadows' until they become legal.  The Chair of the PCT commented earlier in the meeting that 'there are many transitional arrangements and they are not 100% clean" i.e. clearly defined.

 

I will only make two comments:

 

1) What on earth has been the point?

 

2) The remarks about the move away from a market for support organisations may provide some reassurance, but the status of the organisations is unclear (Will they be NHS? How will staff be employed there? Will they have to wind up their jobs and re-apply to the new organisation?  Will they be TUPE'd.).  There still seems to be no absolute guarantee that private organisations will not be involved. 

 

MS