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The health and social care reforms at a glance

8 November 2012

Disability Rights UK wishes to inform its members of the health and social care changes across the NHS and local government. These changes will alter the way older and disabled people, carers and providers are supported by and work with the health and wellbeing system.

Following the Health and Social Care Act 2012, the NHS is undergoing a significant restructure. Strategic Health Authorities (SHAs) will be abolished at regional level and Primary Care Trusts (PCTs) at local level. In their place will be local clinical commissioning groups (CCGs) by April 2013 - groups of GP practices working with other health and care professionals, and in partnership with local communities and local authorities - to commission the majority of NHS services for their local population.

A national NHS Commissioning Board (NHSCB) will oversee the local clinical commissioning groups, and commission certain specialist or national services, for example dentistry and maternity services. The Department of Health will hold the NHSCB to account by the NHS (draft) mandate. The intention is to ‘liberate’ the NHS from direct political control.

Giving local GP practices budgets and commissioning powers instead of PCTs aims to ensure that decisions about patient care and services are placed as close as possible to the patient. At the same time, these changes aim to produce a diverse and plural provider market, where NHS, private, voluntary and not-for profit providers compete for contracts to improve quality and choice of services for patients and the public.

The NHS reforms are part of a wider government effort to shift power to local people and communities and put them at the heart of service delivery, local planning and decision making, through the Localism agenda. The Localism agenda aims to open up public services for delivery by local communities, as well as charities, social enterprises and employee-owned cooperatives, e.g. via a ‘right to challenge’ local authorities and commissioning bodies about their existing provision.

Local authorities will establish health and wellbeing boards, which will be responsible for overseeing the health and wellbeing needs of the local community and for co-ordinating commissioning across a local area according to Joint Strategic Needs Assessments. These boards will bring together key NHS, public health and social care leaders as well as HealthWatch in each local authority area to work in partnership and promote integration and joined up working across health and adult social care and children’s services, including safeguarding.

Local authorities will also establish and fund local HealthWatch organisations, which will take over from current arrangements for public involvement and representation (often through LINKs organisations) and will engage with whole sections of local communities and hold local services to account for their commissioning and delivery decisions.

Local authorities will be able to commission local HealthWatch to provide advocacy and support to help people access and make choices about services, support people who lack the means or capacity to make choices (e.g. helping them choose which GP to register with), and help those who want to make a complaint.

A national body, HealthWatch England, will provide advice, support and
leadership to the local HealthWatch organisations. Local HealthWatch will
provide intelligence for national HealthWatch England and will be able to report concerns about the quality of providers independently of the local
authority.

NHS constitution – ‘The NHS belongs to all of us’
The NHS constitution sets out the rights, pledges and responsibilities of patients, the public and NHS staff, giving a clear picture of what standards of care should be expected from NHS services. The NHS constitution aims to promote and enhance patient involvement and choice in decision making about care.

Market development and regulation
Competition, choice and information are intended to be the key drivers of quality in the new system. Local health services will be opened up to alternative providers under the ‘any qualified provider’ initiative, enabling clinical commissioning groups to commission services from any licensed provider. It is intended that providers (be they from the NHS, the private sector or voluntary and not-for-profit sector) will compete on a level playing field for NHS contracts. The policy of ‘any qualified provider’ is intended to increase competition (and therefore, it is hoped, innovation, improvement and productivity) while reducing barriers to entry to the market. Any provider of NHS services will be required to be registered with the Care Quality Commission (CQC) and be licensed by a new (national) economic regulator, Monitor. While the CQC’s role will continue to focus on maintaining quality standards, Monitor’s key duties will be to promote competition and ensure continuity of services. The competitive market is to be underpinned by an ‘information revolution’ which aims to ensure that patients are empowered to make decisions about their own health, treatment and provider, by being better able to access information and data about services.