The NHS is undergoing continuous reform in its structure, its governance and how it relates to other sectors. We evaluate these changes, examine what they mean at the front line, and look to identify the opportunities and potential problems they create.
As part of our role to monitor the impact of the reforms, we have produced an interactive timeline which brings 70 years of NHS and social care reform to life, and puts the coalition Government’s reforms in historical context.
The Health and Social Care Act 2012
The Health and Social Care Act introduces a number of key changes to the NHS in England. These changes came into being on 1 April 2013. The changes include:
- giving groups of GP practices and other professionals – clinical commissioning groups (CCGs) – 'real' budgets to buy care on behalf of their local communities;
- shifting many of the responsibilities historically located in the Department of Health to a new, politically independent NHS Commissioning Board (this has now been renamed NHS England);
- the creation of a health specific economic regulator (Monitor) with a mandate to guard against 'anti-competitive' practices; and
- moving all NHS trusts to foundation trust status.
Our experts were active in scrutinising and commenting on the proposals at the time of the White Paper and the Health and Social Care Bill’s passage through parliament. We were regularly cited in Parliament and worked closely with MPs and Peers of all political opinions leading up to the Bill receiving Royal Assent.
Our attention has since turned to supporting policy-makers and practitioners on how the reforms can best be implemented. We continue to be, engaged in responding to various aspects of the secondary legislation and guidance, for example the development of the NHS Mandate and Monitor’s consultation on plans relating to licensing of providers and competition. We are also active in debates around the authorisation of clinical commissioning groups.
The NHS faces a huge financial challenge – the question is whether it can respond by delivering more efficient and effective care
Our work in this area is seeing us working directly with agencies charged with implementing the reforms. For example, we have advised the economic regulator Monitor on the development of policy in relation to competition and integration. We also helped Monitor and the NHS Commissioning Board (now renamed NHS England) with their work on pricing and payment reform.
The financial and quality challenge
A key challenge for the NHS involves improving the quality of care and health outcomes within budgets that will grow at a much slower rate than the past decade.
Concerns over the quality of patient care have been thrust centre stage following recent high-profile care failings. In particular, the public inquiry led by Robert Francis QC into care failings at Mid Staffordshire NHS Foundation Trust, published in February 2013 , reiterated the importance of being able to measure and monitor quality of care in health services.
Anita Charlesworth, Nuffield Trust, considers the key challenges for the NHS when coping with a reduced level of funding over the next decade.
In partnership with the Institute for Fiscal Studies and others, our researchers are assessing the potential demands on the health and social care systems over the next decade and mapping the scope for productivity gains.
The centerpiece of our work on care quality will be a five-year research programme that will provide health care professionals, policy-makers and other interested people with independent scrutiny of the quality of health and social care.
This joint Nuffield Trust and Health Foundation programme will track a range of indicators across the NHS and provide deeper analysis in key areas, to help examine how the quality of care is changing over time. It will provide an independent view across all care sectors, reflecting the way that key aspects of quality of care in England are developing over time. The programme will be launched in summer 2013.
Developing a national strategy for the promotion of integrated care
The Government has made it clear that better integration of care must be at the heart of the reformed health system. We are actively involved in this agenda through analysis of effective models of integration, identifying payment reforms to support closer integration and evaluation of integrated systems.
As part of our work in this area, we continue to be consulted by the coalition Government on how best to develop integrated care at ‘pace and scale’.
Photo credit: UK Parliament, Flickr