Field calls for major changes to Bill

Professor Steve Field has set out a vision of integrated care driven by the staff and patient rights set out in the NHS Constitution at the end of the ‘listening exercise’ he was asked to carry out on the government’s reforms.

In a press conference at the King’s Fund today, Professor Field outlined a number of changes that he believes will be needed to the Health and Social Care Bill to bring the changes about.

He also stressed that integrated care records and far more information for patients on the performance of both commissioners and providers would be needed to make the system work.

However, reporters questioned whether the specific changes set out by Professor Field as the head of the Future Forum would be strong enough to alter the more competitive thrust of the government’s reforms.

As expected, the Forum recommended that the commissioning consortia that will take over from strategic health authorities and primary care trusts should use expert advice from hospital doctors, nurses and other professionals, as well as GPs.

It also recommended changes to the role of the regulator Monitor. It said that Monitor should not be an ‘economic regulator’ promoting competition on the model of the utility regulators, but a ‘sector regulator’ supporting “choice, collaboration and integration”.

In the Forum’s model, the health secretary would give the NHS Commissioning Board a mandate that would include setting out the role of choice and competition in the health service, and Monitor would regulate the sector within this framework.

A citizen’s panel would be set up to report to Parliament on whether things were working, and individual citizens and patients would be given a ‘right to challenge’ local decisions, lack of choice and poor services.

Sir Stephen Bubb, the chief executive of the Association of Chief Executives of Voluntary organisations, who produced a paper on choice and competition for the Forum, described this as “bottom up” regulation.

However, when pressed on whether making Monitor a ‘sector’ rather than an ‘economic’ regulator would make much difference to the reforms, he could only say it would “send a significant signal.”

The Future Forum was set up eight weeks ago, after the government was forced to announce a ‘pause’ in the passage of the Health and Social Care Bill, which is supposed to enact the reforms first outlined in the ‘Liberating the NHS’ white paper almost a year ago.

At today’s press conference, Professor Field said it had held ‘thousands’ of meetings and received 25,000 emails.

Overall, he said there was support for change in the NHS, but not for the reforms; sometimes because of a failure of communication on the part of the government and sometimes because it had not worded the Bill well enough.

Professor Field said the Forum had gone back to the NHS Constitution for inspiration, because it stresses that the NHS “belongs to the people.”

He said the current system is fragmented, and there needs to be more collaboration and integration between NHS services and between NHS and social care.

Competition, he argued, could drive quality and accountability if it was introduced within a more integrated system.

The Forum’s report says that “more integrated electronic systems will be a major enabling factor for this.” It also says that patients will need more information to drive ‘bottom up’ regulation and choice.

The paper says commissioning bodies, foundation trusts and other providers should meet in public and publish board papers.

It also says the NHS Commissioning Board and Monitor should publish “accessible and reliable information about services” and that providers should have to publish data on outcomes.

The paper suggests that such information should be delivered in innovative ways “for example, using digital media to deliver personalised messages via mobile phones.”

Asked by eHealth Insider why the Forum had not published a separate paper on IT and information, Professor Field said it had run out of time, but “now the government has to decide whether it wants us to do more work on areas like this.”

The government is due to reply to the Forum’s work tomorrow. It will be up to the government to decide what changes to adopt for the Bill, whether the changes are so big that a new Bill is needed, and when legislation will be reintroduced to Parliament.

However, Professor Field effectively urged the government not to delay, saying that many SHA and PCT offices were already “almost empty” and stressing that the NHS was in danger of losing much-needed managers if it did not clarify their future.

Other changes that the Forum wants to see include: a new duty on NHS organisations and regulators to promote the NHS constitution; safeguards to stop private providers ‘cherry picking’ easy and profitable services; commissioning consortia boundaries to align with local authority boundaries; a bigger role for local health and well being boards in promoting integrated care; and a more independent role for the new Public Health England.