The New Health Reforms

The chance for the public to have their say on the new health reforms.

NRAS is campaigning around the Health Bill, dubbed the biggest change to the NHS since its creation in 1948.  The Bill was officially ‘paused’, during the summer when the Government appointed a group of experts knowne as the NHS Future Forum to undertake an eight-week listening exercise and reported its findings on 13 June 2011. During the listening exercise, NRAS attended a NHS Listening Exercise event with the Prime Minister, David Cameron, and contributed to a consultation response through National Voices. The Government ended up accepted the core recommendations of the report and announced the Bill would be partially re-committed, with certain clauses to be considered again by the Public Bill Committee that had previously scrutinised the whole Bill.

Significant changes proposed by the Government now include renaming GP commissioning consortia as ‘clinical commissioning groups’ (CCGs), with governing bodies to include at least one nurse and one specialist doctor, and have two ‘lay members’ and meet in public. In addition, CCGs will now be supported by ‘clinical networks’ advising on single areas of care, and new ‘clinical senates’ providing multi-professional advice. Commissioners of health services (CCGs and the NHS Commissioning Board) will now have to take active steps to promote the NHS Constitution, including the 18 week limit on waiting times.

The House of Commons Public Bill Committee subsequently held 12 sittings between 28 June and 14 July 2011. The Committee agreed Government amendments to clauses relating to the responsibility of the Secretary of State for Health for providing a comprehensive health service, and to the governance arrangements for commissioning groups.  In mid-August, the Government then asked the NHS Future Forum to continue a new phase of conversations with patients, service users and professionals around four key themes: how to make information improve health, care and wellbeing; how to develop the healthcare workforce to deliver world-class healthcare; how to ensure the Government’s modernisation programme leads to better integration of services around people’s need; and how to ensure the public’s health remains at the heart of the NHS. NRAS has continued to take a close interest, and attending two further listening exercise events in London, one of which being a high-level chairs and chief executives meeting at the Department of Health on the specific issue of integration, where we stressed the importance of enabling more integrating care through the multidisciplinary team model and the need to design a system that offers better integration across primary and secondary care. In addition, NRAS has recently signed-up to National Voices’ vision for integration by signing a letter to the Government in support of its latest publication on Principles of Integration.

Although NRAS still has some concerns over the impact of the new commissioning arrangements on equity of access to treatments and the time taken to obtain referrals, we believe the introduction of clinical networks and clinical senates may help to reduce disparities between services. However, we still believe more needs to be done to incorporate the voice of patients and patient-led organisations into local decisions about commissioning and we continue to work closely with the Arthritis and Musculoskeletal Alliance (ARMA) and National Voices to further these objectives.

Within the new health reforms the Government has also made it clear that Quality Standards will serve an important role in shaping clinical outcomes for NHS patients, with the National Institute of Health and Clinical Excellence (NICE) now being tasked with developing a library of around 150 new Quality Standards. These standards usually contain 10-15 statements describing what high quality looks like based on the best available evidence. These sit alongside more detailed clinical guidelines, which will continue to be produced. It is the Government’s intention to write these standards into the contracts between the new NHS Commissioning Board and CCGs in order to hold commissioners to account. Given their importance, NRAS has been busy pressing the case for one on RA and we are pleased to note that a Quality Standard for RA is currently included in the draft library of topics. In addition, NRAS Chief Executive Ailsa Bosworth has been working behind the scenes with the Health Quality Improvement Partnership in England and the RA cause received a further boost when the Government recently announced that a new national clinical audit is to be undertaken to improve the quality of clinical practice and evaluate clinical practice against clinical criteria and clinical guidelines.

Alongside this, the Government is also committed to making an extraordinary £20bn of savings in the NHS over the next 4 years. One of the main ways they are hoping to achieve this is through the Department of Health’s (DH) Quality, Innovation, Productivity and Prevention (QIPP) programme, which includes a workstream around ‘long-term conditions’ that is seeking to improve the clinical outcomes and experiences of people within this grouping. NRAS continues to be active on this issue, entering a DH competition earlier this year for new, innovative indicators to provide good measures of health outcomes for the NHS Outcomes Framework. At the same time, we are continuing to support the Royal College of Nursing Frontline First campaign and feedback any contact we have with healthcare professionals, where they report problems caused by the NHS cuts. Working with Arthritis Research UK, NRAS is also monitoring the development of the Government’s pilots around Personal Health Budgets, which fall under the QIPP programme.

The NHS Future Forum is now due to report its findings on all four work streams in December 2011. Meanwhile, the Bill is currently going through its Committee Stage in the House of Lords, having survived two votes during its Second Reading which called for the Bill to be dropped and for the competition part to be referred to a special Lords Committee for additional scrutiny.

NRAS has been very active in the consultation documents that have been produced by the Department of Health as a consequence of the Governments reform of the NHS.

It is vitally important that we are able to have our say and put forward the key points that we feel need to be made, to ensure that we can receive the best care and support that people with RA need. We will continue to respond to the various consultation documents as they are issued and we will update you further as this work progresses.

NRAS have contributed to the following Consultations:

•   The NHS Constitution
•   The Disability Allowance Framework
•   Commissioning
•   The Information Revolution
•   Choice and Control in the NHS

Publications:

Liberating the NHS: commissioning for patients - consultation on proposals. Response from NRAS.
Please click here to download


NRAS Response to the Disability Allowance Consultation
Please click here to download


NRAS Response to Consultation Repsonse on White Paper Relating to ‘Greater Choice and Control’.
Please click here to download


Response by the National Rheumatoid Arthritis Society (NRAS) to the Department of Health’s The NHS Constitution: a consultation on new patient rights.
Please click here to download


NRAS Response to The Information Revolution  
Please click here to download