A number of commentators have listed 10 things Labour should do to restore our NHS, when they are elected in 2015. Here is my first go at a list.
For context by then the Health & Social Care Act 2012 will have been fully passed into law and much of the implementation will have taken place. So no NHS Trusts; CCGs, Health & Wellbeing Boards, Healthwatch, NCB all in place more or less as envisaged; 30 – 40 mergers involving Foundation Trusts but many FTs still not financially viable; maybe 5 ex NHS Trusts in limbo under franchised management or managed from centre; more services run under Any Qualified Provider; more services put out to tender and competition for the market. A few major reconfigurations (service closures like A&E and Maternity) but only in safe Labour areas.
Progress will have been made to deliver the Nicholson Challenge but the funding situation will be dire and true financial position opaque. Social care will still be a scandal and funding unreformed. Longer waits, more restrictions on access, some indications of preference to private patients; attempts at forms of indirect top up payments. Less staff, falling patient satisfaction; many alienated and cynical GPs and clinicians. And that’s the good bits.
The Act is repealed and a new Act is brought in to consolidate a plan with a basis of widespread support (as in 2000 NHS Plan).
Anyway in no particular order, 10 Things To Do:
- Restore unambiguously the power and duty on the Secretary of State to intervene in any part of the system where the SoS believes this is in the best interest of the NHS.
- Introduce a national system for health and social care assessment, including national criteria for financial assessment and begin the implementation of a system to make all personal social care free at point of need, as with health care.
- Give tier one local authorities, through their Health & Well Being Boards the power to sign off all care commissioning plans and to enforce alignment with the HWB Strategy.
- Ensure Public Health and Mental Health gain greater prominence and influence in the system with fair funding; and incentivise integration around the patient – whole person care.
- Give Healthwatch, locally and nationally independence and adequate secure funding.
- Require CCGs to have stronger governance with a Board having a majority of properly appointed NEDs.
- Encourage and incentivise the convergence of Clinical Commissioning Groups and Health & Well Being Boards into Commissioning Authorities, reducing the number of commissioning bodies and ensuring coterminosity.
- Introduce Commissioning Reviews to allow commissioners to determine that the most appropriate way to deliver all or any part of services shall be through arrangements with one or more health services bodies or one or more NHS Foundation Trusts; (allowing commissioners to sign NHS Contracts which are not legally enforceable with NHS providers).
- Abolish Monitor and create a single regulator for quality and governance. Use licensing by the regulator to prevent unsuitable providers and to enforce full disclosure of all information (no commercial confidentiality opt outs).
- Move all price setting back to the Department of Health, reduce scope for payment by results and allow commissioners local flexibility over payment mechanisms.
These could be done without major reorganisation and without much in the way of new legislation.