Health and Social Care Bill

With the showers has come a certain malaise tinged with queasy uncertainty.

This could be a post-Bill slump in the NHS, a response to the long grind of making cuts with no end in sight, and the sheer weight of detail to be worked through with respect to the mass reorganisation outlined in the now Health and Social Care Act.

The queasiness extends beyond health, look at local Government for example facing an average six per cent cuts rather than a ‘flat real’ settlement as in health.

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The introduction of the Health and Social Care Act 2012 was trumpeted in some quarters (including, apparently, the Cabinet room) as a hard-won victory for Andrew Lansley and his plans to ‘liberate the NHS’.

For the battalion of health service managers, however, the campaign has now begun in earnest. It is they who have to take the legislation, translate its complex clauses into practical plans, and determine how far Lansley's hopes will be realised and the fears of his detractors proven or not.

NHS...

High stakes with the Health and Social Care Bill last week. But at our Health Policy Summit 2012 we pushed aside for a minute big reform, structures, and long run consensus-dividers such as competition/choice, public/private, and command versus autonomy.

Instead, we majored on – as guest Don Berwick so thoughtfully put it – ‘contextually adaptive changes’.

A physician who was formerly chief of the Centers for Medicaid and Medicare and the Institute for Healthcare Improvement, Don was upbeat that with the right changes...

The Nuffield Trust’s fourth Health Policy Summit opens on Wednesday, bringing together senior health leaders, clinicians, policy-makers and academics. The timing is not auspicious.

The intense political wrangling over the Health and Social Care Bill has spilled out beyond Westminster and is dividing professionals in the NHS. Even at this late stage the Bill’s passage through Parliament is uncertain.

Whatever you might think of the Government’s proposals, the financial challenge that predated them is now a reality for the NHS. It is also rapidly becoming...

Last year the Archbishop of Canterbury attacked what he described as "the quiet resurgence of the seductive language of the deserving and undeserving poor".

The pressure to make huge savings within the NHS, coupled with the commissioning agenda and the introduction of private competition to that process could see the deserving and undeserving poor joined by the deserving and undeserving sick. This can't be right. After all, no one chooses to be sick.

When I hear insulting terms like "frequent flyers" being used to describe people who are sick and need...

Andrew Lansley's woes are multiplying by the hour this week as efforts mount to block the Health and Social Care Bill.

Resistance might be expected from the British Medical Association (BMA) and the Royal College of Nursing (RCN) and other unions, but it is now more widespread and even reported from deep in his own party, among cabinet colleagues. The public are bewildered and staff in the service doing a difficult job while debate rages and the...

This is a question that we knew we had to answer in a clear and convincing manner when the Nuffield Trust and The King's Fund were asked by the Department of Health to contribute to the development of its strategy on integrated care. 

Our report of this work: Integrated care for patients and populations: Improving outcomes by working together, has now been published.

We are all too aware of the fact that 'integrated care' and 'integration' can sound rather dry and hollow as concepts, leaving most people puzzled that care could ever be...

I’m only a couple of months into my year in the USA.

Breakfast with Lansley. Lunch with Berwick.  A chance meeting with Obama (Michelle, not Barack). And dinners with more top-rate health care academics, analysts and policy-makers from around the world than would have seemed possible just a few short weeks ago.

With this has come slides – lots of slides. Slides showing how bad things are here. Slides showing how good things are there. Slides showing how Japan is doing its best to make everyone look average, and slides showing how India plans to break the mould in eye-...

‘Integration, integration, integration’ may not yet be on Channel 4 at 8pm on a Wednesday night but it is right up there on the agenda of the NHS.  It’s a central theme of the Health and Social Care Bill; it’s one of the key areas for the Future Forum’s second listening exercise; and perhaps, to quote Chris Ham, “it’s an idea whose time has come.”

Our involvement with the Nuffield Trust, participation in the listening exercise and in the newly convened ‘Integrated Care Discovery Community’ here in the northwest, has given us...

In September, Andrew Lansley accepted the Independent Reconfiguration Panel’s recommendations to proceed with changes to services at Chase Farm hospital in North London. These changes continue to be very unpopular locally, but as the Secretary of State’s statement acknowledged, these were hard choices about the safety and sustainability of services. And then he added: “This is not about money. We are not making cuts to local services.”

Whether or not local campaigners agree, this statement...

Integration remains a central theme in the Health and Social Care Bill, with work in progress around the country to try and make services less fragmented for patients and their carers.

At a recent workshop exploring how integrated care might be developed at pace and scale, which marked the launch of a new Nuffield Trust and King’s Fund project to support the development of a national strategy for the promotion of integrated care, participants agreed that financial pressures have created a ‘burning platform’, and that integration could improve patient...

I was struck by the general appetite for a more open debate about rationing and priority setting at a recent conference on priority setting in health held by the University of Birmingham’s Health Services Management Centre (HSMC) and the Nuffield Trust.

The conference focused on the experiences of primary care trusts (PCTs) in making difficult choices. During the morning session HSMC’s Dr Suzanne Robinson introduced findings from research published by the Nuffield Trust that explored current priority-setting...

If the Government hoped it could draw the sting of opposition to its reform plans by pausing the legislation in early summer, it has been mistaken. As the Health and Social Care Bill is made ready for its second reading in the House of Lords, voices are still calling for the entire Bill to be scrapped. 

Critics argue that the reforms are too disruptive, unpopular and unnecessary. In particular, there is entrenched suspicion of the Government's intentions about the use of the private sector to deliver NHS services, despite the Government’s amendments to the Bill. 

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The Health and Social Care Bill is in better shape now. There are still some gaps (failure and designated services being the biggest) but best for the politicians to pass it and turn their focus to more pressing issues in the NHS – achieving more value for money. That is our main assessment as outlined in our initial response to the Bill Committee: Memorandum to the Public Bill Committee for the Health and Social Care Bill.

We are left thinking that the whole policy-making process has been less than desirable. Perhaps an overambitious reform...

When the NHS White Paper was published a year ago, it diagnosed three main pathologies for which major reform was the prescribed solution: weak commissioning; insufficient competition and choice; and excessive micro-management from the political centre. 

The prescription set out an array of medicines to deal with these ailments including: GP commissioning ‘consortia’ in place of primary care trusts; an economic regulator to promote competition among ‘any qualified provider’ of NHS-funded services; and a new more strategic role for the Secretary of State, with more power and...

I was in Glasgow earlier this month speaking at a British Geriatrics Society (Scotland) symposium about community services for older people.  Two things struck me: first, how refreshing it was to be at a conference where England’s Health and Social Care Bill was barely mentioned; and secondly the abundance of practical examples of health care integration from across Scotland.

One of the major criticisms of the Health and Social Care Bill was that its emphasis on promoting...

The debate about price competition in the NHS is a very good example of a more general point: the impact of competition in health care will depend on the ‘rules of the game’.

The Health and Social Care Bill sets out some of the parameters for competition but much of this is of necessity very broad and open to interpretation.  This job of interpretation falls largely to the new economic regulator – Monitor.  Its approach (or regulatory stance in the jargon) will have a profound effect on the way competition evolves over the coming years.

The market mechanism session of...

Is it time to move beyond commissioning? This was the question posed by Dr Judith Smith  to the panel in a debate session at the Nuffield Trust’s annual Health Strategy Summit 2011.  The question arose from a cool appraisal of the research evidence on 20 years’ experience of NHS commissioning in England – evidence which points to very limited impact by commissioners on secondary care, and a struggle to make the shift to community-based care that has been long exhorted in policy.

Judith highlighted some persistent problems with...

Andrew Lansley, the Secretary of State for Health, arrived at the Nuffield Trust summit intending to announce some new developments in Payment by Results.  But the questions and debate following his speech came to be dominated with other questions, including whether the government really plans to introduce competition on price and abolish mandatory NICE guidance in the future.

The audience was rewarded with clarity on the first question. There would be no competition on price, he explained. There...

The quest for better, more efficient health services requires innovation, new ways of working and new behaviours across every area of care. The message from the summit was that innovation and change will flow from everywhere – patients, individual clinicians, managers and large organisations.  

We were challenged at the start of the conference by two proponents of the Big Society, Phillip Blond of ResPublica and Geoff Mulgan of the Young Foundation. Phillip Blond argued that innovation would flow if the NHS can avoid capture by the private sector and instead actively foster...