The government has said it will make the changes to the Health and Social Care Bill recommended by the Future Forum report.
Here’s all the key reaction:
Chris Ham, chief executive of The King’s Fund
“Today’s announcement signals a more promising approach to meeting the health challenges of the future than the proposals originally set out in the Health and Social Care Bill. Demographic change and the increasing numbers of people with long-term conditions require a new model of care based on stronger collaboration between health professionals and more effective co-ordination of services. We therefore strongly welcome the emphasis on delivering integrated care and look forward to working with the government to achieve this.
“The confirmation of the Prime Minister’s pledge to keep waiting times low, and the emphasis placed on the 18-week maximum wait for hospital treatment enshrined in the NHS Constitution, leaves the NHS with a very significant challenge. With the spending squeeze beginning to bite, the number of hospital inpatients waiting more than 18 weeks for treatment is already at its highest level for more than three years and waiting times for A&E and diagnostic services have also risen. As the government has said that it is opposed to targets, it now needs to be clear about how this pledge will be measured and enforced.
“Although we need to see the proposed amendments to the Bill, there is much to welcome in the detail of today’s announcement, including the emphasis on clinical commissioning, a more nuanced approach to competition and an evolutionary approach to implementing the reforms. However, the sheer number of changes being made to the structure of the health system risks creating confusion and additional bureaucracy. The government will need to specify very clearly how these bodies will operate and work together.”
Dr Clive Peedell, co-chair NHSCA
“The NHS Consultants’ Association believes that the proposals of the NHS Future Forum to water down the Health and Social Care Bill do not go far enough and therefore calls on the coalition Government to withdraw the Health and Social Care Bill before more damage is inflicted upon the English NHS.
“The Future Forum has proposed some significant revisions to the Bill, some of which we strongly welcome, but it has failed to address the medical profession’s key concerns about increasing marketisation and privatisation of the English NHS, because the key policy levers driving these processes remain intact. The focus on the use of competition between a plurality of any willing/qualified providers still lies at the very heart of this bill. It is therefore no surprise that the coalition Government has accepted the proposals.
“The NHSCA accepts the need for changes to the NHS, but the coalition government has failed to articulate the correct arguments for change and has come up with the wrong solutions. The proposed market based system will only increase NHS privatisation and fragmentation, creating more inefficiency and will ultimately lead to a mixed funding system of healthcare.
“The NHSCA believes that significant revisions to such a large, controversial and deeply unpopular piece of legislation require proper scrutiny and this will not be possible if the Bill is forced through Parliament by the coalition government. Many of the Future Forum’s proposals will require significant extra layers of bureaucracy increasing NHS costs at a time when £20 billion of efficiency savings are required by 2014. This is why the NHSCA believes that the bill should be withdrawn with immediate effect.”
Mr John Black, president of the Royal College of Surgeons
“The government should take great credit for taking time to listen to concerns from healthcare professionals and patients over the detail of the health reforms. Amendments announced today to formally include hospital doctors in commissioning will help ensure all patients are fully accounted for and prevent unintended destabilisation of hospital services. Commitments to prohibit cherry picking of cases and to maintain medical training are welcome - the RCS has provided detailed advice on these points that we hope will be taken up in the coming months.
“But the best thing for the future of the NHS is to get on with making these plans a reality without delay. Our experience of past attempts to reform the health service is that open ended commitments are never fulfilled as there are too many confounding vested interests in the system. Removing the 2013 deadline would prove a mistake. Our concern is that this opens the door to a mixed economy of commissioning by new consortia in addition to alternative commissioners creating wasteful duplication of how NHS money is spent. This could lead to funds being spent on administration that could have gone on patient care at a time when public finances are at their most vulnerable.”
Sir Richard Thompson, president of the Royal College of Physicians
“The Royal College of Physicians (RCP) welcomes the government’s commitment that hospital doctors will be on the boards of local commissioning groups, as the RCP previously urged. We believe this will benefit patient care by bringing together clinical colleagues in commissioning decisions. The renaming of commissioning consortia to clinical commissioning groups will reflect the collaboration from a wide range of experts to commission the best services for patients.
“The RCP has urged that seamless care is more likely to be achieved when hospital doctors are involved in the highest level of commissioning decision making - sitting on the decision making boards of commissioning groups. In turn, we would like GPs to sit on the boards of foundation trusts. In this way all doctors will work together to lead a health service in the best interests of patients.
“The commitment to strengthen clinical networks is important, particularly their role in advising the National Commissioning Board. The new duty for clinical commissioning groups to promote integrated services for patients across the NHS and social care is a step in the right direction.
“We welcome the commitment for the NHS Commissioning Board to have strong links with the royal colleges. The RCP conducts clinical audits and produces clinical guidelines with strong clinical input and based on robust evidence. We stand ready and willing to inform standard setting and outcome measures, which will drive up quality throughout the NHS. The work to develop quality measures for the NHS must start now to ensure clinical commissioning groups can purchase services based on outcomes. We look forward to entering dialogue with government about this.
“The removal of Monitor’s role to promote competition and the commitment that it will ensure a level playing field across providers goes a long way to meeting our concerns. We look forward to influencing the guidance that will be developed between the National Commissioning Board and Monitor that will set out how choice and competition should be applied, and how services should be integrated. The government has stated that Monitor’s duty will be to protect and promote patients’ interests. The Health and Social Care Bill must clearly reflect these commitments. The RCP now waits to see how these commitments will reconcile choice and patient safety.’
“While we are pleased that the government has recognised our concerns that there is a need for ‘a safe and robust transition for the education and training system’, without fundamental review the government’s current proposals for reform medical education and training will put the next generation of doctors’ training at risk and could jeopardise patient safety. We support the early implementation of Health Education England to retain a national perspective on setting standards and planning the medical workforce, but the vital role that deaneries play in planning, organising and delivering postgraduate medical education and training must be maintained, not just through the period of reform, but also in the long term.”
Dr Hamish Meldrum, chairman of BMA council
“We are pleased that the government has accepted the Future Forum’s core recommendations, and that there will be significant revisions to the Health and Social Care Bill. We will need to look carefully at the details of the changes, but it seems clear that what we are likely to see is a very different Bill, and one which puts the reforms on a better track. There is much in the government’s response that addresses the BMA’s concerns, and many of the principles outlined reflect changes we have called for. The success of the reforms will very much depend on how the various elements link together and work on a practical level, and on how much they engage clinicians and patients locally.
“We welcome the shift in the role of Monitor away from promoting competition. However, while we have always supported the principle of greater choice for patients, it has to be workable. There will need to be robust safeguards to ensure that vital services are not destabilised by unnecessary competition.
“More detail is needed about the way clinical commissioning groups will operate in practice. While greater accountability and transparency around their decision-making processes are welcome, they should not be encumbered by bureaucracy.
“It is reassuring that the government recognises there are still a number of issues to work through. It is particularly important that dialogue continues on education and training and the development of incentives for commissioners. We look forward to continuing our discussions with the government to help ensure that NHS reform is best for patients and workable for staff. Hanging over all this, however, is the fact that the NHS is facing unprecedented financial pressures. The focus on structural reform must not distract us from the task of minimising the impact of funding cuts on care.”
