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â€˜Liberating the NHSâ€™ Implications of the NHS White paper. Ian Holmes Associate Director, Economics and System Management. The case for change. â€œHealth outcomes lag behind much of Europe Inequalities have not narrowed Services are unresponsive and place low value on â€œcustomer careâ€
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The NHS should focus on the outcomes that matter to patients and communities - Process targets to be replaced by an outcomes framework Competition and choice used to drive quality and respond to local needs
GPs and patients should make decisions on how to improve health and outcomes together – Information – choice is only effective if made from a position of knowledge about alternatives GP commissioning – aligning decision making with the people closest to the patientPCT abolition – PCTs ‘abolished by the end of 2012-13.
Improvement in healthcare has been held back by political interference and too much bureaucratic control–Independent NHS commissioning board - Abolition of SHAs - Abolition of Audit Commission. - A regulatory approach replacing a system management approach.
Knowledge and spending power should be aligned with responsibility and accountability: –GP Commissioning- Specialist and maternity commissioning with NHS board
Greater competition between providers will lead to more rapid improvement in quality and efficiency: –Level playing field overseen by economic and quality regulation- Full separation of commissioning and provision functions- A failure regime – and protection of essential services.
Strategic decisions will work better with local ownership: –New health and wellbeing boards located in local government- Local government responsible for JSNA
We have failed to make sufficient progress on health inequalities: –New national public health service- Ring fenced health promotion funds- Integration of DsPH roles into local government
SHAs as system managers have a legal duty under the Civil Contingencies Act 2004 to maintain the NHS’s ability to respond to any disruptive challenge.
How will this function be delivered in the healthcare system of the future?
These duties fall into three key functions:
Warning and Informing the Public – led by Communication and media – How will this be led in the future?
Management Coordination – Who will be the accountable officer in the future? – This currently being managed through the Regional Health Emergency Planning Executive Group.
Protecting the Public – health prevention and health protection
The new Public Health Service to consider – national work being undertaken – Green Public Health paper Autumn 2010.
In 2010-11, the final year of higher funding, our organisations have identified a requirement of £350m efficiency savings, in order to an aggregate surplus of £150m.
By 2014-15, the requirement is in the region of £1.77bn if the 2010-11 efficiency requirement is included. Excluding 2010-11, the efficiency requirement is in the region of £1.4bn.