The Government is proposing major changes to the way the NHS is organised in England. Our experts have made a priority of examining the planned reforms in detail since the White Paper Equity and Excellence: Liberating the NHS was published in June 2010. All our resources, including publications, blogs, video interviews and consultation responses, are available from this page.
Director of the Nuffield Trust, Dr Jennifer Dixon, outlines the ideas contained in our response to the Government’s NHS ‘listening exercise’.
NHS Operating Framework 2012/13
The NHS Operating Framework holds out the prospect of another very challenging year for hospitals and commissioners in the NHS, with providers facing a drop in prices of at least 1.5 per cent. While managerial ‘grip’ is understandable given the pressures on the NHS, the Nuffield Trust is calling on the NHS Commissioning Board to use its ‘shadow’ year to explore how it can create a permissive culture that lends itself to innovation, in the midst of financial discipline.
Other recommendations include:
Taking a cautious approach to the expansion of payment by results for mental health services;
Strengthening the voice of patients and carers;
Monitoring the quality of care patients receive in cases where the prices paid are below tariff.
The Government’s Health and Social Care Bill makes provisions for a number of key changes to the NHS in England, including:
Giving groups of GP practices and other professionals – clinical commissioning groups – ‘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;
The creation of a health specific economic regulator with a mandate to guard against ‘anti-competitive’ practices;
Moving all NHS trusts to foundation trust status.
The Bill was published in January 2011 but its progress was delayed when the Government initiated a ‘Listening Exercise’ on 6 April 2011 in response to concerns about the proposed reforms. This was led by the NHS Future Forum, chaired by Professor Steve Field, and professionals, patients, members of the public and policy experts were consulted. The NHS Future Forum published its recommendations on 13 June and the Government response to the NHS Future Forum report was published on 20 June.
Our experts are examining the Government’s NHS reforms in detail and highlighting aspects of the legislation that merit greater scrutiny
The Bill has now reached the House of Lords where it will undergo further scrutiny before gaining Royal Assent. Read the briefing we have prepared for peers in advance of their first debate. You can also watch a recording of Nuffield Trust Director Jennifer Dixon’s appearance before the panel of MPs who were charged with examining the Bill in detail following the NHS Listening Exercise. We submitted a report to them earlier this year, which contains our preliminary analysis of the major changes to Parts 1 and 3 of the Bill, and itself builds on our formal submission to the NHS Future Forum: The Health and Social Care Bill: where next?.
For earlier Bill-related commentary, see the January 2011 briefing we circulated to members of parliament in advance of the legislation’s second reading debate, and our March 2011 paper: NHS reforms in England: managing the transition, which assessed the 2011/12 Operating Framework for the NHS together with guidance on the operation of Payment by Results (PbR) in 2011/12. This summarises the main challenges associated with managing the transition to a reformed NHS, as envisaged in the White Paper: Equity and Excellence: Liberating the NHS, and proposes ways in which the risks associated with transition might be mitigated.
Commissioned surveys
The Nuffield Trust has also conducted a ‘snapshot’ survey of health leaders to test their views and attitudes towards the Government's NHS reforms. While not a comprehensive, representative sample of views among policy-makers and expert opinion on the NHS, the findings outlined in our report: Snapshot survey of health leaders on the Government’s NHS reforms, provide a useful insight into the views of health leaders.
We supplemented this analysis by commissioning Ipsos MORI to survey a representative sample of the public (1,000 people) in England, to explore their views on the reforms – download the findings and view the key slides.
The online community Doctors.net.uk conducted two further surveys of their members in partnership with the Nuffield Trust to shed more light on GPs’ expectations of how consortia will work and the support they believe they will need. Download the findings of the Doctors.net.uk and Nuffield Trust surveys, and view the key slides for the January 2011 and February 2011 polls.
NHS White Paper
The Health and Social Care Bill was preceded with the White Paper: Equity and Excellence: Liberating the NHS, published in July 2010. This was followed on 20 October 2010 by the announcement in the Spending Review that the NHS would receive 0.4 per cent real terms growth over the next four years to 2014/15 – i.e. 0.1 per cent per year. As part of this, £1 billion a year of NHS funding will be transferred to social care. The real terms change in the NHS funding, net of the social care support, is a reduction of 0.5 per cent over the next four years. This compares to an average real terms increase of 5.7 per cent from 1997/98 to 2009/10. Relative to the rest of the public sector, the Spending Review produced a good result for health but the challenge for the NHS is tough.
We played a lead role in the debates leading up to and beyond the publication of the White Paper and Spending Review, and responded with a comprehensive analysis of the key reforms and developments in:
These reports were submitted to the Department of Health as part of its consultation on the White Paper, which came to a close in October 2010. In addition, we also responded to the specific White Paper consultation documents that were published by the Department of Health:
