Read Andrew Lansley's statement to the Commons on his plans for NHS reform, as he reveals the changes the government is prepared to make to the bill.
With permission, Mr Speaker, and further to the Written Ministerial Statement I laid in the House earlier today, I wish to make a statement on the government’s response to the NHS Future Forum.
We established the independent Future Forum on 6 April, under the chairmanship of Professor Steve Field, to look again at our proposals on the modernisation of the NHS. Yesterday it published its report and recommendations.
I would like to thank Professor Field and his 44 senior colleagues from across health and social care who have worked so hard these past eight weeks.
I would also like to thank the more than 8,000 members of the public, health professionals, and representatives from over 250 stakeholder organisations who attended some 250 events across the country. Also the tens of thousands who wrote to us with their views. I want also to thank the many officials in my Department who supported this unprecedented engagement across the country.
I said two months ago we would pause, listen, reflect and improve our plans. Our commitment to engage and improve the Bill has been genuine and has been rewarded with an independent, expert and immensely valuable report and recommendations from the NHS Future Forum.
I can tell the House that we will ask the Forum to continue its work, including looking at the implementation of proposals in areas including education and training and public health.
In his report, Professor Field set out clearly that the NHS must change if it is to respond to challenges and realise the opportunities of more preventative, personalised, integrated and effective care.
They said the principles of NHS modernisation were supported: to put patients at the heart of care; to focus on quality and outcomes for patients; and to give clinicians a central role in commissioning health services.
In the Forum’s work, they set out to make proposals for improving the Bill, and its implementation; to provide reassurance and safeguards; and to recommend changes where needed. As Prof. Field put it, they did this not to resist change, but to embrace it, guided by the values of the NHS and a relentless focus on the provision of high quality care and improved outcomes for patients.
Mr Speaker, we accept the NHS Future Forum’s core recommendations.
We will make significant changes to implement those recommendations and, in some cases, offer further specific assurances which we know have been sought. There are many proposed changes and we will publish our more detailed response shortly. But I would now like to tell the House some of the main changes we will make.
Duties on the Secretary of State
The Bill will make clear that the Secretary of State will have a duty to promote a comprehensive health service, as in the 1946 Act, and be accountable for securing its provision and for the oversight of the national bodies charged with doing so.
We will also place duties on the Secretary of State to maintain a system for professional education and training within the health service, and a duty to promote research.
Clinical Commissioning Groups
One of the most vital areas of modernisation to get right is the commissioning of local services.
For commissioning to be effective it must draw upon a wide range of people when designing local services – including clinicians, patients and patient groups, carers and charities.
We will amend the Bill so that the governing body of every Clinical Commissioning Group will have at least two lay members – one focusing on public and patient involvement, the other overseeing key elements of governance, such as audit, remuneration and managing conflicts of interest.
And while we should not centrally prescribe the make up of the governing body, it will also need to include at least one registered nurse and one secondary care specialist doctor. To avoid any potential conflict of interest, neither should be employed by a local health provider.
These governing bodies will meet in public and publish their minutes. The Clinical Commissioning Groups will also need to publish details of all contracts they have with health service providers.
Clinical Senates and Networks
To support commissioning, the independent NHS Commissioning Board will host “clinical senates”, providing expert advice on the shape and fit of healthcare across a wider area of the country; and will develop existing clinical networks, who will advise on how specific services, like cancer, stroke or mental health, can be better designed to provide integrated, effective care.
Building on this multi-professional involvement, Clinical Commissioning Groups will have a duty to promote integrated health and social care around the needs of their users.
To encourage greater integration with social care and public health, the boundaries of Clinical Commissioning Groups should not normally cross those of local authorities. If they do so, Clinical Commissioning Groups will need to demonstrate to the NHS Commissioning Board a clear rationale for doing so in terms of benefit to patients.
I have always said that I want there to be “no decision about me, without me” for patients when it comes to their own care. The same goes for the design of local services.
So we will further clarify the duties on the NHS Commissioning Board and Clinical Commissioning Groups to involve patients, carers and the public.
Commissioning Groups will have to consult the public on their annual commissioning plans and involve them in any changes that would affect patient services.
Choice and competition
One of the main ways that patients will influence the NHS will through the exercise of informed choice. We will amend the Bill to strengthen and emphasise commissioners’ duty to promote patient choice.
Choice of Any Qualified Provider will be limited to those areas where there is a national or local tariff, ensuring that competition is based solely on quality. And this tariff development, alongside a ‘best value’ approach to tendered services, will safeguard against “cherry-picking”.
Monitor’s core duty will be to protect and promote the interests of patients. We will remove its duty to “promote” competition as though that were an end in itself. Instead it will be under a duty to support services integrated around the needs of patients and the continuous improvement of quality. It will have a power to tackle specific abuses and restrictions of competition that act against patients’ interests. Competition will be a means by which NHS commissioners are able to improve the quality of services for patients.
We will keep the existing competition rules introduced by the last Government – the Principles and Rules for Co-operation and Competition – and give them a firmer statutory underpinning. The Co-operation and Competition Panel, which oversees the rules, will transfer to Monitor and retain its distinct identity
And we will amend the Bill to make it illegal for the Secretary of State or regulator to encourage the growth of one type of provider over another. There must be a level playing field.
We will strengthen the role of Health and Wellbeing Boards in local councils, making sure they are involved throughout the commissioning process, and that local health service plans are aligned with local health and wellbeing strategies.
In a number of areas, we will make the timetable for change more flexible: to ensure that no one is forced to take on new responsibilities before they are ready, while enabling those who are ready to make faster progress.
If any of the remaining NHS Trusts cannot meet Foundation Trust criteria by 2014, we will support them to achieve it subsequently. But all NHS trusts will be required to become foundation trusts as soon as clinically feasible, with an agreed deadline for each trust.
We will ensure a safe and robust transition for the education and training system. It is vital that change is introduced carefully and without creating instability, and we will take the time to get it right, as the Future Forum has recommended. During the transition, we will retain postgraduate deaneries, and give them a clear home within the NHS family.
On Any Qualified Provider, its extension will be phased carefully to reflect and support the availability of choice for patients.
Strategic Health Authorities and Primary Care Trusts will cease to exist in April 2013. By April 2013, all GP practices will be members of either a fully or partly authorised Clinical Commissioning Group or one in shadow form. There will be no two-tier NHS.
However, individual Clinical Commissioning Groups will not be authorised to take over any part of the commissioning budget until they are ready to do so. GPs need not take managerial responsibility in a commissioning group if they don’t want to. April 2013 will not be a ‘drop dead’ date for the new commissioners.
Where a clinical commissioning group is not able to take on some or all aspects of commissioning, the local arms of the NHS Commissioning Board will commission on its behalf.
Those groups keen to press on will not in any way be prevented from becoming fully authorised as soon as they are ready.
Mr Speaker, I also told the House on 4 April that we would secure proper scrutiny for any changes we made to the Bill. In order to do this, without trespassing on the House’s time to review the Bill as a whole at Report, we will ask the House to recommit the relevant parts of the Bill to a Public Bill Committee shortly.
Mr Speaker, through the recommendations of the NHS Future Forum and our response, we have demonstrated our willingness to listen and to improve our plans. To make big changes.
Not to abandon the principles of reform, which the Future Forum themselves said were supported across the service. But to be clear that the NHS is too important, and modernisation too vital, for us not to be sure of getting the legislation right.
The service can adapt and improve as we modernise and change. But the legislation cannot be continuously changed. On the contrary, it must be an enduring structure and statement. So it must reflect our commitment to the NHS Constitution and values. It must incorporate the safeguards and accountabilities which we require. It must protect and enhance patients’ rights and services. And it must be crystal clear about the duties and priorities which we will expect of all NHS bodies and in local government for the future.
Professor Field’s report says it is time for the pause to end.
Strengthened by the Forum’s report and recommendations, we will now ask the House to re-engage with delivering the changes and the modernisation the NHS needs.
I commend this statement to the House.