Analysis of the amended Health and Social Care Bill, published today by the Nuffield Trust, draws attention to some key issues that escaped detailed scrutiny when time ran out during the report and third reading stages in the House of Commons.
The briefing, which has been circulated to members of the House of Lords in advance of their second reading debate next week, warns that although the legislation sets up an outline of how the new organisations will perform, much will depend on the culture and modus operandi of these bodies as they carry out their functions. It encourages peers to use the time they have available to push for as much contextual detail about implementation as possible.
Issues that the Trust believes should be the subject of focus in the House of Lords include:
- Whether the clauses relating to the Secretary of State's duties will allow reasonable autonomy for NHS organisations from both ministers and the new arm's length bodies, while at the same time ensuring that the Secretary of State remains politically accountable for the performance of the NHS to Parliament;
- The impact of the authorisation process, the way in which the competency of CCG boards will be measured and assured, and the extent of the freedom CCGs will have to design financial incentives for their member practices;
- The continuing lack of detail about how providers will access funds, including through the proposed 'NHS Bank' and why the latter is not proposed to be independent of the Department of Health;
- Whether, given the complexity of the health care system, it would be preferable for Monitor rather than the Office of Fair Trading to evaluate the impact of mergers on competition as well as on patient and public interest.
The briefing ends by calling for a swift resolution to the Bill in the interests of providing the health service with much needed strategic certainty, warning that further protracted negotiations run the risk of alienating the many clinicians and other groups across the NHS whose commitment will be vital to the effective implementation of what is still a complex reform programme.
Ruth Thorlby, Senior Fellow at the Nuffield Trust comments:
‘If the Government has genuinely shifted away from its original market-inspired reform plans, it needs to articulate a new vision of what will drive improvement, efficiency and innovation in the NHS. This model must allow for genuine local autonomy for clinicians to innovate, delivering public accountability without a reversion to central control.
‘In addition, if the Bill does enable organic growth and innovation, it will be more vital than ever that the Commissioning Board puts in place new mechanisms to spot what works to improve value in health care. The mechanism to do this at present is extraordinarily weak. Without such knowledge, future development will lack a robust empirical basis and it will be hard to make the critical progress needed towards higher value and more sustainable financing in the NHS.’