The All Party Parliamentary Group on Primary Care and Public Health has produced a report urging the government to rethink the scale and pace of its proposals, embodied in the white paper Equity and Excellence: Liberating the NHS.
The proposals include giving GPs responsibility for commissioning services, scrapping PCTs and SHAs, improving patient information, increasing provider competition and focussing the NHS on health outcomes.
The following is the report’s summary and recommendations:
The vision of the NHS white paper, putting patients and the public first and improving health outcomes are excellent aspirations. Much of what is proposed in the white paper is ambitious and requires a great deal of support and leadership in the NHS not to mention a significant amount of vision on the part of users and those working in the health system.
The structural changes are vast and will result in a very different NHS to the one we know now and some respondents refer to this as “the new world”.
Reforms such as these require far more detail than is available in the NHS white paper in fact many proposals are lacking detail although, when questioned, the health minister told us the NHS white paper is deliberately a brief statement of government’s vision.
There is no doubt that government is committed to encouraging people to take greater interest in their health and take responsibility for it. Its ethos of “no decision about me without me” is proof of this and the provision of health information is a major priority in the white paper.
However information - especially online - is not enough and won’t reach everyone and so we feel more should be done. One way of encouraging health engagement is through health professionals. People and the public trust professionals working in the NHS and so health professionals are ideal in assisting people to realise their full potential in looking after their own health.
There is no mention of how new commissioning organisations will take on public and patient engagement for their local areas. Whilst it is good that local populations will drive local services it is essential that patient and public engagement is not lost in favour of bigger priorities.
A national programme to ensure patients understand how to use health services and how to take care of their own health is also needed and is something that should be encouraged at national level.
Whilst encouraged by government’s obvious commitment for greater health engagement and look forward to seeing these policies fully implemented as planned, with our recommendations taken into consideration, we have concerns about the scale and pace of the structural reforms proposed in the white paper and the potential loss of crucial expertise as a consequence.
Question: will the NHS white paper deliver the health improvements expected by government?
Many of the proposals made in the NHS white paper are positive and could potentially deliver the health improvements expected by government. The lack of detail around proposals however deters us from emphatically saying whether government’s vision will be realised.
Recommendation one: more information should be made available on how government proposes to implement many of the policies in the white paper.
Question: will engaging the public and professionals save money and save lives?
It is clear that health engagement is necessary for the future of the NHS and the white paper contains encouraging strands of engagement for example, its ethos of “no decision about me without me” and the promise of shared decision making consultations. However, the failing is the lack of detail once again. There is no clear implementation plan on how these elements will work in practice. To begin with we feel it is essential that all NHS interactions have at the heart of them an element of self-care and self-management whether this is during a GP consultation or a visit to A&E.
Recommendation two: for the NHS staff of the future we recommend colleges and universities include in their training elements of how to engage patients into helping themselves and take responsibility for their own health. Staff must empower patients and enable a more fulfilling two-way consultation thus co-creating better health outcomes.
Recommendation three: for current NHS staff there is a need for training courses, to help professionals realise their potential in encouraging greater positive health behaviours in their patients and the public.
These should be supported by incentives in frameworks such as QOF to encourage those working in the NHS to include self-care education as part of their consultations and interactions with patients.
Question: have we given enough time to embed the last major reconfiguration and could SHAs and PCTs have been part of the solution?
We have been convinced that with a few modifications to PCTs and encouraging greater local health partnerships, the vision government is seeking could be met without embarking on the radical reforms being proposed.
The reforms such as they are will also be extremely costly, result in a drop in productivity in the NHS and there is also the real threat of losing crucial expertise that currently exists in PCTs and SHAs and we are concerned for the future of the health system if these experts are lost.
Recommendation four: we recommend government re-think the scale and pace of structural reforms and approach it in a more measured way that will ensure continuity of management and leadership. This can be done by building on existing arrangements, strengthening GP commissioning within current structures and streamlining the organisation of the NHS by reducing the size and numbers of PCTs gradually as functions are handed over to commissioning consortia at a more progressive rate.
Recommendation five: we recommend that if government intend to continue with their reforms as they are now, then it is imperative the transition period is managed properly to include an effective plan for transferring the expertise that lies within these organisations and ensure the growing body of knowledge on patient and public engagement is not lost to the new commissioning consortia and the NHS Commissioning Board.
Question: does the white paper have what it takes to achieve the fully engaged scenario through greater engagement and increased productivity?
We are convinced that achieving the Wanless, fully engaged scenario will be a great challenge in the NHS especially in light of the structural reforms which will divert attention away from driving up productivity.
We conclude it is important to intensify levels of engagement to help efficiency savings and NHS productivity during these challenging times.
Recommendation six: we recommend more is done beyond online information to support people taking responsibility for their own health. We recommend the implementation of public health information programmes nationally and locally that incorporate social marketing to ensure the right messages are aimed at the right people at the right time in their lives.
Recommendation seven: we recommend also that this is made national legislation to ensure new organisations understand the importance of health engagement.
Recommendation eight: we recommend programmes are fully evaluated with respect to their impact on health behaviour with on-going research to ensure we continue to understand why people adopt unhealthy behaviours and who would benefit from change.
Question: what can be done to improve productivity in the NHS?
We conclude that the greatest way of improving productivity in the NHS is for greater engagement and communication between everyone involved in the NHS. Partnership working is essential to ensure a patient centred NHS and this is recognised in the NHS White Paper.
Recommendation nine: we recommend the expertise and experience of all healthcare professionals including secondary care clinicians, nurses, managers, therapists and pharmacists as well as GPs are maximised to ensure the new system works. It might be necessary to have in place a framework of principles for NHS organisations in order to ensure everyone is clear in what is expected of each other. This is especially important in the “new world”.
Read the full report findings.
Tags: Commissioning, Health policy, PCTs, SHAs
