This document discusses reforms to the NHS from 2010 onward including: 1. The 2010 White Paper proposed giving GPs responsibility for commissioning and abolishing PCTs and SHAs to reduce management costs. 2. Responses from medical groups expressed concerns about risks of GP commissioning and privatization. 3. A House of Commons committee report recommended changes like broadening commissioning groups and ensuring public accountability and integration of services. 4. In response, the government committed to wider clinical involvement, stronger protections against a market system, and greater choice for patients while pursuing evolution over revolution of the NHS.

2. NHS Reform and the Healthcare Landscape Dr Tim Ringrose

3. 3 1948 World Health Organization (WHO) is established Mahatma Gandhi assassinated Communists seize power in Czechoslovakia Orville Wright dies Olympics held in London Alice Cooper, Olivia Newton-John & Prince Charles born Warner Brothers shows the first color newsreel Columbia Records introduces the long-playing (33-1/3 RPM) record Cortisone introduced as an arthritis treatment Allergan founded

4. 4 1948

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6. 6 Satisfaction with the NHS: 1997 – 34% 2009 - 64%

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8. 8 Population pyramid 2:1 Baby boom The pill 1:1 ONS 2009

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12. Increasing democratic accountability and public voice

13. Liberating provision of NHS services

14. Strengthening public health services

16. Equity and Excellence: Liberating the NHS Giving responsibility for commissioning health care to GPs and their practice teams working in consortia The creation of an independent NHS Commissioning Board to allocate resources to and oversee GP consortia The abolition of strategic health authorities (SHAs) and primary care trusts (PCTs) The introduction of an outcomes framework for holding the NHS Commissioning Board to account The transfer of responsibility for public health to local government Greater freedoms for providers of health care and an aspiration to see more social enterprises The creation of an economic regulator that will set prices, promote competition and ensure continuity of essential services.

17. 14 Are GPs equipped? Privatisation Public Health?

18. How did doctors respond? 15

19. 16 24% agree Only 22 per cent of doctors believe that the NHS will be able to maintain its focus on increasing efficiency while implementing the proposed reforms October 2010, 500 GPs and 500 Hospital doctors

20. 17 Best ways for NHS to achieve efficiency savings

21. 18 Response from medical groups took some time to crystallise BMA "Clearly, the changes proposed are significant and wide ranging. Many consider the White Paper to be something of a large curate’s egg; good in parts, bad in parts, unclear in parts and even internally inconsistent in parts.” July 2010 “The BMA has major concerns about many aspects of the Health and Social Care Bill and has been a vocal critic warning about the most damaging of the proposals, including the highly damaging role of Monitor in promoting competition. Doctors attending yesterday’s SRM reaffirmed the widespread concern about the plans and because of this called on the Secretary of State to withdraw the Bill.” March 2011

22. 19 Growing alarm from all sides “The sheer scale of the ambitious and costly reform programme, and the pace of change, while at the same time being expected to make £20 billion of savings, is extremely risky and potentially disastrous” Peter Carter, Royal College of Nursing “Cameron should get real and start listening to the people who know about the NHS August.“ Dave Prentis, Unison “There are clear risks of introducing GP commissioning when the government has placed such a strong emphasis on reducing management costs.” Jennifer Dixon, Nuffield Trust “extraordinarily risky” NHS Confederation

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24. April –2nd Health Select Committee report on commissioning Broaden the composition of commissioning groups Ensure public accountability Encourage integration between primary and secondary care 21 “The government’s plans to reform NHS commissioning needs to be significantly changed” Stephen Dorrell

25. Secretary of State must remain ultimately accountable for the National Health Service. Commissioning consortia to have a governing body that meets in public. There must be effective multi‐professional involvement in the design and commissioning of services working in partnership with managers – “Senates”. Experienced managers must be retained. Commissioning consortia should only take on full range of responsibilities when they can demonstrate that they have the right skills, capacity and capability to do so – extend timetable Monitor to support choice, collaboration and integrationrather than competition. Private providers should not be allowed to ‘cherry pick’ patients. Better integration of commissioning across health and social care should be the ambition for all local areas. Independent, expert public health advice at every level of the system. 22

26. 23 “The fundamentals of our plans – more control for patients, more power to doctors and nurses, and less bureaucracy in the NHS – are as strong today as they have ever been. But the detail of how we are going to make this all work has really changed as a direct result of this consultation.” David Cameron

27. Government’s response to the recommendations Wider involvement in clinical commissioning groups Stronger safeguards against a market free-for-all Additional safeguards against privatisation Evolution, not revolution Greater information and choice for patients Breaking down barriers within and beyond the NHS Investing for the future of the NHS 24

28. Where now? Did we really need a health bill to do this? Is this too little to address the structural changes needed? Is there enough to encourage integration of healthcare? Is there enough emphasis on public health? Is this addressing the financial challenges? What role will private providers play? What is the role for pharma? 25