Future Forum


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


  • 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


  • 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


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


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


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


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


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


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


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


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