PRESS CONFERENCE June 13th 2011
Steve Field Chair, plus 4 panel members including Steven Bubb, Julie Moore
Key points to be covered today:
- Competition to support choice promote integration – not end in itself
- Many cited need to continue with intervention
- GPs – not alone on consortia
- Primary duty of Monitor to promote comp should be removed ‘requiring Monitor to support choice, collaboration and integration’
- Overwhelming views Pace of change too fast
Key Recommendations
Everything heard based upon enduring values of NHS
Amendments: Obvious that many wanted actively promoted NHS constitution
Patients and staff – based on rights and responsibilities negotiated with unions 2yrs ago
Terms of Sec of State Responsibility -misunderstandings a plenty
NHS should be free from day to day political interference but SoS must remain ultimately accountable
Patients and Carers
- Equal partners and citizens in co-operation – but not tokenistic or paternalistic
- Choice in partnership
- Shared decision making
Transparency
- Comm Consortia should have transparent governing body because NHS ££
- Effective indep reps to protect public interest
- Nolan Principles of Public Life
- Board Meets in Public and papers published – incl Foundation Trusts Trusts
Foundation Trusts
- Monitor’s compliance role in terms of making Trust fit for purpose
- Govs need appropriate knowledge and skills
Commissioning
- Massive input into opinion re health professionals and commissioning
- ALL professions should be engaged in commissioning
- The Clinical Senate – expert help and advice, linked to Health & Well Being Board
Managers
Alarmed and distressed at how demoralised managers over past few months, How marginalised – Many fleeing
Believe v strongly – managers have critical role in working with and supporting clinicians – MUST do something v quickly so don’t lose to ensure :
- Smooth transfer
- Nicolson QUIPP Challenge – managing finances
Heard Commissioning Consortia are a good idea – with
- Appropriate patient input
- Comprehensive – ALL GPs to be part of Commissioning Consortium
PACE
All should move to being accredited – April 2013 too onerous for some
Cambridgeshire Pilot should be encouraged to advance so can learn lessons
NHS Commissioning Board should support this as direction of travel – this will be the model
CHOICE
Patients want it
The Choice Mandate – Commissioning Board
Using the Market if Appropriate
Addressing Health Inequality – seen as key reason to pursue this
Citizens Panel as part of Healthwatch England – eg rural hosp not good enough’
- links in with Localism Bill
- Local pops more control over healthcare is gd idea
‘Competition not used as end in itself – just as a tool to promote integration and improve quality’
SIGNIFICANT DILUTION OF MONITOR: Primary duty re Competition should be removed. Nothing to do with Utility Regulators – VERY different for Health
Cherry Picking – ‘Levelling playing field’ with private providers to prevent this – for example to include funding education and training…(how would this help!!)
Duties placed on Secretary of State re equalities and inclusion is welcome
Local Level – Health & Well Being Boards to be generators of Health & Social Care integration. Want them to have stronger powers to look at commissioning. Boards and funds
INTEGRATION
Care around needs of patient – micro
Consortia not crossing LA boundaries unless very good reason
Co-terminosity is not really achievable NB. Pilot sites for places like Torbay & Hereford
EDUCATION & TRAINING
Workforce paper needs more work and more time
Multi-disciplinary approach. Home for deaneries in short term and bigger debate later. Concerns how variable professional development support is for staff – some nothing for 30yrs!
Industry publishes CPD etc – varies too much across the whole range – include dentistry. National Quality Board – urgent work to see improvements
PUBLIC HEALTH
Proveider /Commissioner duty to co-operate In order to protect population of England
Concerns Public Health England needs independent voice – arms length body.
Clinical leaders and managers all believe in NHS – v worried about success – want to move forward to make sure meet financial challenge, based upon :
- Quality
- Safety
- Financial Challenge – agreed at local and national level
GOVERNMENT SHOULD ACCEPT RECCOMMENDATIONS TO MOVE THINGS FORWARD
Look forward to Govt response
Issue that’s not meant to be a political football. Time for political argument has come to an end. Now urge politicians to work together to take forward for sake of patients. Golden opportunity for NHS to create vision for future to meet challenges of quality, co-morbidities, financial situation
PRESS QUESTIONS
Jason Beattie ( Mirror ) asks if amendable – should it be a whole new Bill? Field – not for him to say. Govt will determine
Is it possible to have competition and collaboration working side by side? Jeff ~ important to see how patients receive integrated care in homes. In order to get that need models of joint commissioning between local government and NHS. Can also have competition . – look at who using competition as a means of improving
Bubb – believes VERY strong evidence competition drives quality. Suggest rather than duty on Monitor to get choice/comp should be more onus on citizen right to challenge
Bottom up rather than top down regulation. ‘Error to suppose properly regulated competition is a threat to free at point of need delivery – reverse is probably true’. Helps protect NHS into future. Is in integration that competition can play a particularly strong role
Financial times – Clarify who on Consortia? Field- Should not be going for tokenism. Correct decisions to be made – only with full range of skills including nurses and hospital doctors. In addition, when want to Commission can bring in whole range of other specialists. Set up group to advise and input. Consortia retain decision making – GPs will lead – yet to find a Pathfinder who isn’t using a nurse in Consortium
Sam Lister – Times – Anything Prime Minister & DPM won’t accept? Loooong pause from Field. Papers are a distillation of what we have heard over the past 8 wks – even recently new thoughts. Not sure what response will be but look forward to it
Unknown reporter – Management costs? VERY steep target to reduce – does this need to be ‘weakened’? Female panel member: Lots of staff gone – no idea what is right target for efficient and effective management. Great concern good people won’t want to come into service. Distressed – not appropriate to slag off. Should be thanks for what people have done before they got the boot!
Field – Should be a turning point – acknowledge managers have same values and beliefs in providing quality care. Move on together working differently – especially if care moves out of hospitals. Can’t afford to lose our best managers
C4 News? ’Freeing NHS from day to day political interference but accountable’ – sounds almost meaningless!
Field ‘appears to change SoS’ responsibilities…… Clearer that should be SoS responsibility but NHS Commissioning Board takes over intervention etc
ABB- 31,500 people consulted – but anxiety and concerns about what’s going on. Strike action by nurses, 38 degrees – Where do these groups fit into the listening exercise? Field ‘ hugely encouraged by feedback about values of NHS – and need to change’
BBC What about re-configuration impacts? Field – Strengthened Health & Well Being Boards in recommendations. Clinical Senate – coming together of all groups including social care. Commissioning Board > SoS about re-configuration. Trying to get more decisions made locally. More patient and public involvement and professional actions by profs
BUBB 70% on long term conditions. Focus of debate tends to be hospitals. Suggest focus needs to move form hospitals to how we provide integrated care. Will inform how we get resources right. How we need better working between charities, hospitals, private providers – system thinking differently how to drive integration which would then work with a better balance. Right to Challenge and Personal Budgets will help to drive change
Telegraph – Transparency: sign providers of services need to publish docs – does this include independent providers? Create transparency through commissioning & contracting processes – a bit of a challenge! Field acknowledges as public money we should all know how spent. Also not possible for patients to choose in an informed way
Michael Crick 8 weeks – twice said only concluded only in past couple of days – Prime Minister a couple of hrs ago. Rushed? Better with more time? Friday draft – no leaks!! Some areas need a lot longer to work on: Julie’s area to stop medical education falling apart. Cathy’s area – more work on networks – more on assurance process of Consortia. More on Public Health
Crick If no move forward there as hardly any staff in PCTs or SHAs – need to move forward. Ludicrous Secretary of State only has 4 days instead of 4 months??
Field – we look forward to them telling them what their timescale is!!
ANR ?How work Mon keep Office of Fair Trading but deal with challenge under Competition Law? BUBB Concurrent powers. EU Competition Law issue. By heaving a Health Sect regulator rather then Economic Regulator such as Office of Fair Trading ties in with recommendation with duty to promote competition
Does this make a blind bit of difference?? BUBB – gives a signal. Monitor ought to be regulator to stop bad practice not competition
Field – had lots of legal advice. A lot of what people fear about Monitor is unlikely to happen if doing their job. If prime responsibility is to encourage collaboration, choice and regulation. Language used is very unfortunate ( Lansley lang ). Wouldn’t do it if starting again
Competition is there to aid Collaboration, Choice and Regulation Missing is info and transfer to integrated care model via patient access to records
C4 News Gary Gibbon To what extent dealing with presentational issues? To what extent bad things substantively had to change?
Field – some really good things lost in translation- Concerns re things not there. Things not helpful in the Bill – particularly Monitor; Education & Training; Clinical leadership of Consortia – government needs to respond favourably; With changes – will be an effective sector regulator. Should never have been set up like a utility regulator. In some areas will be needed where services are not good enough. Also Information needs a lot more work If get it right truly world class health service meeting patient needs. More efficient, more patient focused. Very sound principles
IMPLEMENTATION ? Field all very positive. We’ve all learned such a lot. Government can learn a lot from the process as well as the detail Cites Guardian Open Meet as being most challenging !
Right involvement and right approach re skills base and training. Taking account of multiple professional clinicians when designing services. Recommends representation of Clinical Senate on Health & Well Being Boards
Jos Bell June 13th 2011