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Government's NHS reform proposals put more power into hands of frontline staff and patients


Power will be devolved from Whitehall to NHS professionals meaning GPs will have much more control over staffing, pay, benefits, and workforce planning.

Secretary of state for health Andrew Lansley yesterday set out the Government's ambitious plans to reform the NHS during this Parliament and for the long-term. The idea behind Lansley’s announcement is to put clinicians and patients at the heart of the NHS, cut bureaucracy and put more power in the hands of frontline staff.

GPs will be handed the majority of the commissioning budget and local authorities will be given control of local health improvement budgets, the health secretary announced. Professionals will be free to focus on improving health outcomes so that these are among the best in the world.

Under the proposals all NHS trusts will become foundation trusts and will have the same rights to set pay locally as foundation trusts do now.

Pay decisions will be led by employers rather than imposed by the Government and it is recognised that many providers will want to continue to use national contracts as a basis for their local terms and conditions.

In the short term, during the two-year pay freeze, the Government will ask the pay review bodies to make recommendations for staff earning under £21,000 and will consult with employers and trade unions on long-term arrangements.

Healthcare employers and their staff will determine workforce development and training needs and these decisions will determine education commissioning. The NHS Commissioning Board will provide national oversight of healthcare providers’ funding plans for training and education and GP consortia will provide this oversight at a local level.

The white paper is the start of an extensive consultation that will take place over the coming weeks. The Department of Health will shortly be publishing a number of consultation documents and NHS Employers and the NHS Confederation will be working with NHS organisations to ensure their views are represented.

NHS Employers has signed a new contract with the Department of Health to ensure NHS Employers continues its core work, including supporting employers to meet the challenges of the difficult financial period that lies ahead.

Nigel Edwards, NHS Confederation acting chief executive, said: "Signing a new contract with the Department of Health is excellent news and demonstrates confidence in NHS Employers as an organisation capable of delivering high-quality services.  We look forward to working with both the Department of Health and staff side partners in delivering services for the NHS that help organisations meet their workforce challenges in the next few years."

The contract broadly reflects the work NHS Employers currently does including managing negotiations on pay, pensions and primary care contracting; providing support and tools for employers on health and wellbeing; workforce capacity and flexibility; medical education and training; professional standards and regulation; equality, diversity and human rights; staff and employer engagement; the Social Partnership Forum; and communications. The core contract will be worth £11.7 million in its first year.

Sir Keith Pearson, NHS Confederation chairman, added: "The NHS Confederation has faced some issues recently following the NHS Employers member model project. This was a commercial venture, and such ventures are not always successful. 

"We have worked with our independent auditors to understand the reasons why this was the case, and we have been working hard to ensure that the necessary lessons are learned.

We have put in place an action plan, which has been shared and closely scrutinised by the Department of Health to ensure their confidence in our handling of public funds. I am pleased that we have demonstrated our probity to their satisfaction, and signing the contract means we can move forward with the recruitment of a new senior management team to lead its delivery. 

"The NHS Confederation, with NHS Employers, is emerging from this experience as a stronger organisation with improved governance that will ensure we properly evaluate and manage risk in future."

The white paper also means patients will get more choice and control, backed by an information revolution, so that services are more responsive to patients and designed around them, rather than patients having to fit around services.  The principle will be ‘no decisions about me without me’. 

Under the new plans, patients will be able to choose which GP practice they register with, regardless of where they live, and choose between consultant-led teams.  More comprehensive and transparent information, such as patients’ own ratings, will help them make these choices together with healthcare professionals.

Groups of GPs will be given freedom and responsibility for commissioning care for their local communities.  Providers of services will have new freedoms and they will be more accountable. There will be greater competition in the NHS and greater co-operation. Services will be more joined up, supported by a new role for local authorities to support integration across health and social care. 

As a result of the changes, the NHS will be streamlined with fewer layers of bureaucracy.  Strategic health authorities and primary care trusts will be phased out.  Management costs will be reduced so that as much resource as possible supports frontline services.  The reforms build on changes started under the previous government.

Lansley said: "The NHS is our priority. That is why the coalition Government has committed to increases in NHS resources in real terms each year of this Parliament.  The sick must not pay for the debt crisis left by the previous administration. But the NHS is a priority for reform too.  Investment has not been matched by reform.  So we will reform the NHS to use those resources far more effectively for the benefit of patients.

"The Government’s ambition is for health outcomes – and quality services – that are among the best in the world.  We have in our sights a unique combination of equity and excellence.

"With patients empowered to share in decisions about their care, with professionals free to tailor services around their patients and with a relentless focus on continuously improving results, I am confident that together we can deliver the efficiency and the improvement in quality that is required to make the NHS a truly world-class service."