NHS Consultation, Operating Frameworks and PCT Revenue

Wednesday 15th December 2010 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

Today I am laying before Parliament “Liberating the NHS: Legislative framework and next steps” (Cm 7993), the Government’s response to the consultation on implementing the White Paper reforms set out in “Equity and excellence: Liberating the NHS”. Sir David Nicholson, the NHS chief executive, is also today publishing the NHS operating framework and revenue allocations to primary care trusts (PCTs) for 2011-12. The operating framework and revenue allocations have been placed in the Library. Copies of all documents are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

“Liberating the NHS: Legislative framework and next steps” shows how the Department has developed its plans in the light of consultation and sets out further detail on the reforms and a timetable for implementation. The document also sets out a timetable for implementation and explains how the consultation has shaped the health and social care Bill, planned for introduction in January. Overall, the document reaffirms the Government’s commitment to reforming the NHS so that it:

puts patients right at the heart of decisions made about their care;

puts clinicians in the driving seat on decisions about services; and

is focused on delivering health outcomes that are comparable with, or even better than, those of our international neighbours.

The Department received over 6,000 consultation responses from patients and members of the public, clinicians, voluntary organisations, patient representative groups, local authorities, local involvement networks (LINks), NHS organisations and staff, independent providers, pharmacists, academics, professional bodies and royal colleges, think-tanks and trade unions.

Responses contained a broad mix of support, suggestions for improvement and critical challenge. The insights and suggestions we have heard in consultation have not only strengthened our belief that the reforms are necessary but have also helped us refine our proposals in several areas. In particular, the Government have decided to:

significantly strengthen the role of health and well-being boards in local authorities, and enhance joint working arrangements through a new responsibility to develop a “joint health and well-being strategy” spanning the NHS, social care, public health and potentially other local services. Local authority and NHS commissioners will be required to have regard to this;

create a more distinct identity for Health Watch England, led by a statutory committee within the Care Quality Commission;

increase transparency in commissioning by requiring all GP consortia to have a published constitution;

change our proposal that maternity services should be commissioned by the NHS Commissioning Board;

extend councils’ formal scrutiny powers to cover all NHS-funded services, and give local authorities greater freedom in how these are exercised;

phase the timetable for giving local authorities responsibility for commissioning NHS complaints advocacy services, and allow flexibility to commission from other organisations as well as from local Health Watch;

give GP consortia a stronger role in supporting the NHS Commissioning Board to drive up quality in primary care; and create an explicit duty for all arm’s length bodies to co-operate in carrying out their functions, backed by a new mechanism for resolving disputes.

Equally important, the feedback we received through consultation has also helped us refine our approach to implementation, in order to create flexibility, empower local leadership, and support the significant cultural change and staff engagement that respondents highlighted would be needed to make our reforms a success. The Department has therefore decided to:

allow a longer and more phased transition period for completing our reforms to providers;

create a clearer, more phased approach to the introduction of GP commissioning, by setting up a programme of GP consortia pathfinders; and

accelerate the introduction of health and well-being boards through a new programme of early implementers.

To take forward these changes the Department has put in place a single, integrated programme for the whole of the transition across the health and care system. This will help sustain performance under the existing regime at the same time as building the leadership to implement the changes. Transition will occur through a carefully designed and managed process, phased over the next four years, to allow for rapid adoption, system-wide learning, and effective risk-management. It will be aided by the creation of a number of specific time-limited transitional vehicles, with a focus on sustaining capability and capacity.

Alongside “Liberating the NHS: Legislative framework and next steps”, the NHS chief executive, David Nicholson, has today published the NHS operating framework for 2011-12, which sets out the priorities for the next year. This includes how the NHS will go through a strong and stable transition over the next year to begin to deliver the vision of the White Paper. By the end of 2011-12 we expect NHS organisations to have made significant progress in moving towards a more liberated NHS. Organisations should be working across traditional boundaries to improve the quality of patient care while maintaining the quality and safety of NHS services.

I have also written today to every hon. Member in England detailing their PCT’s allocations for 2011-12, which PCTs will use to deliver our vision for reform and our national priorities as set out in the operating framework.

Total revenue investment in the NHS in 2011-12 will grow to over £102 billion. The allocations I am announcing today will provide PCTs with £89 billion to spend on the local front-line services that matter most, an increase of £2.6 billion, or 3%. This funding includes an increase of £1.9 billion in PCT recurrent allocations (including £150 million for re-ablement), £69 million in primary dental services, pharmaceutical services and general ophthalmic services non-recurrent allocations, and £648 million to support joint working between health and social care.

The recurrent allocations are based upon a revised weighted capitation formula that includes improvements, such as a new mental health formula. This lays the groundwork for the switch to allocations to GP consortia and local authorities from the NHS Commissioning Board and Public Health England respectively for 2013-14. These organisational changes will free the NHS from political interference, support the transfer of decision making and responsibility for local health services to the front line, and ensure that public health programmes are safeguarded.

PCTs and local authorities will use the funding for re-ablement and joint working to agree a work plan based on local joint strategic needs assessments to deliver services which may include current services, in particular telecare, re-ablement packages and home adaptations.

The allocations announced today place PCTs in a strong position to deliver the coalition Government’s vision for reform, as originally set out in “Liberating the NHS” and today reaffirmed in “Liberating the NHS: Legislative framework and next steps”. and our national priorities, today set out in the NHS operating framework.