Ten things you need to know about the Health and Social Care Bill

Yesterday saw the release of a critical report from the cross-party Health Select Committee on the Health Minister, Andrew Lansley’s proposals to reorganise the NHS. Stephen Dorrell, the Committee’s Chairman and former Health Secretary, said that “the NHS should focus on achieving efficiencies rather than on management upheaval”.

Whatever you think of the Bill, it signifies the most fundamental changes in the sixty year history of the NHS – and the role for local authorities in health will increase significantly bringing new opportunities, challenges and responsibilities.

We therefore thought it would be useful to outline 10 key things that you need to know about the Bill.

  1. Overview of the Bill. The Bill is intended to improve quality and cost effectiveness in health through improved commissioning. It establishes the national NHS Commissioning Board and local clinical commissioning groups (CCGs). Responsibility for public health will transfer to local authorities who will also establish health and wellbeing boards (HWBs) to lead integrated commissioning and provision.
  2. The debate is not yet over.  The Bill has had a rocky passage and further amendments, on issues such as limiting competition and increasing transparency in CCG governance, have been proposed in the Lords. The government may accept some changes to ensure that the Bill is passed before the end of the Parliamentary session. Subject to the Bill’s enactment, most reforms should be in place by April 2013.
  3. Many reforms are already underway. Strategic health authorities have been formed into four clusters – North, South, Midlands and London. The 151 PCTs have been clustered into 50 groups each with one chief executive. CCGs are considering their configurations. There is considerable uncertainty for staff and organisations at a time when £20bn in NHS savings is required.
  4. HWBs are now forming. Over 90 percent of local authorities opted to become early implementers. In some areas, HWBs are viewed as providing some stability during a time of transition. Early implementers stress the importance of organisational development approaches to establish new relationships. Note: districts are not included as they are not responsible for setting up HWBs (although District councils may be represented on HWBs).  
  5. Some shadow HWBs have started work. Some are mainly focusing on elements of reform such as the transfer of public health, establishing CCGs, establishing HealthWatch, and developing Joint Strategic Needs Assessments and joint health and wellbeing strategies. Others are also starting to consider joint commissioning.
  6. Overall, there has been support for public health reform. But now there are concerns about a lack of detail on implementation, and on how budgets will be identified and allocated. A baseline expenditure exercise in PCTs resulted in wide variations. The DoH have published factsheets and some guidance (all of which we have covered in briefings this month) and published a public health outcomes framework this week (briefing to follow). There is still uncertainty about the finances to be made available and its distribution. The DH say it will publish a finance update soon and further information on the health premium. An engagement team, chaired by the chief executive of Hereford Council, has been set up to road-test policy.
  7. The government has stated that CCGs should not normally cross council boundaries. The original pathfinders ranged from populations of under twenty thousand to over five-hundred thousand. Now, smaller groups (possibly less than 200,000 patients) are unlikely to be authorised. HWBs will give a view on local structures, and discussions with CCGs should be taking place.
  8. Councils will have a larger role in health beyond the interface with social care and public health. HWBs will be involved in the development of CCG commissioning plans and have the power to refer these back to CCG boards or even the NHS Board if they do not take account of the joint health and wellbeing strategy. The NHS Board (subnational) will work with HWBs.
  9. The new system will face challenges. For instance, reconfiguring unviable (but probably valued) NHS services is seen as critical by the DH. There are also concerns about potential conflicts of interest in CCGs through GPs taking on a commissioning role. Quality of healthcare provision is likely to be an on-going issue.
  10. When considering what to prioritise, councils should focus on developing an effective HWB and good partnerships with CCGs. They will also need to define the roles of the HWB and Scrutiny, and promote public involvement through developing a robust local HealthWatch.

This is our list, so what do you think? What have we overlooked? Please leave comments in the box below.

LGiU issues regular policy briefings for members on the Health and Social Care Bill and how it’s being implemented. These briefings are available to all LGiU subscribing members. We also occasionally publish free briefings on this blog – to subscribe, please follow this link.

This article first appeared in the December issue of C’llr mag.

Went to the launch this morning by John Denham of the government's 'Strengthening Local Democracy' consultation.  These are my first thoughts on hearing him and skimming the document. The starting point of this consultation is the right one: the recognition that councillors and councils should lead communities, and shape all the local public services, because they have a “unique democratic mandate”. The consultation is a very practical one. Gone is the airy language of ‘empowerment’. Instead John Denham identifies priority areas where he sees scope to increase the role and powers of councils. John Denham clearly recognises that local action will have the greatest impact to tackle climate change. We are pleased to see that he wants to build on the LGiUs carbon trading project which is highlighted in the consultation. Only councils have the understanding of local patterns of carbon emissions as they relate to economic and social progress. The proposals reflect the ideas we have shared in recent weeks with the government, and the work we are continuing with the launch of our Carbon Trading Public Sector programme. Proposals to enhance local democracy in health services are good to see. For too long this massive part of the public sector has been run from Whitehall. The LGiU will respond calling for local primary care trusts to be run by local councillors, who should make up a majority of the membership of the Trust Boards. This simple step will put people who have a mandate into a position where they can exert much more influence in health, and connect health to other key local services, particularly social care. Proposals to extend powers, and the resources, for councils to scrutinise a much wider range of local services, including utilities, will only be worthwhile if they have real teeth. Finally, it is good to see that the government is taking up our proposals to put local government’s role and powers in relation to central government on a statutory footing, including the LGiU’s suggestion for a joint parliamentary committee. The problem with this consultation is that John Denham is approaching localism from the beginning at the end of the government’s term. I asked the Secretary of State today how any of these proposals will see the light of day in the short time before the next election. John Denham’s response is that we, the supporters of stronger local democracy, have to help him persuade his colleagues across government that there is an urgent need and a real demand to localise now. We will be taking up this invitation to redouble our work to take our message to all parts of Whitehall. In the meantime I will be urging John Denham not to wait until the consultation ends ‘in the Winter’ to get on with implementing those ideas that don’t require legislation and where a consensus exists already between local and central government.