Since the Coalition Government came into office we have seen a raft of changes in public policy driven by requirements to reduce spending, featuring stringent cuts from the top down. Policy decisions will be made locally, such as GP commissioning in the NHS. The concept of ‘Big Society' features greatly, with the role of the Third Sector expanding to fill the gaps created by shrinking public services.
What are the implications for the Assist UK network? Many local services are already facing funding cuts and other challenges, but are there opportunities too? In the lead-up to the local elections the Government is ‘pausing for thought' about some of the reforms it proposes. There may be some concessions in the pipeline, such as a greater role for nurses in GP commissioning, but the prospect of a mixed health and social care economy is unlikely to change - so where might the reforms lead? Now is the time to reflect on developments and consider the possibilities. To help with this links to source documents for further information are given at the end of this article.
Themes emerging from health and social care reforms
Three ‘P' words repeatedly feature in the white papers, guidance documents and policy papers published in the last six months - they can be summed up as:
Equity and Excellence: Liberating the NHS (June 2010) outlined NHS reforms, comprising three ‘mutually-reinforcing' parts:
A patient-centred NHS - Patients and their carers will be in charge of decision making about their health and well-being
Better healthcare outcomes - The mechanism to drive quality improvements will be the National Healthcare Outcomes Framework.
NHS accountability - There will be greater autonomy for doctors and nurses and greater accountability to patients and the public, focussed on outcomes.
The Department of Health (DH) will re-focus on public health, working with voluntary and private sectors to achieve its objectives, as set out in Healthy Lives, Healthy People (December 2010). Nationally, Public Health England will be operational from April 2012. Locally, Health and Wellbeing Boards will lead on the strategic co-ordination of commissioning across the NHS, social care, related children's and public health.
"A Vision of Adult Social Care: Capable Communities and Active Citizens" (2010) includes proposals for:
Prevention - LAs will lead on health improvements
Personalisation - a new legal framework, providing an entitlement to a personal budget, which may be combined with a personal health budget
Plurality and partnership - addressing the barriers to market entry for small social enterprises, user-led organisations and charities and improving budget alignment across sectors
Consultation is underway on creating a ‘level playing field' for ‘civil society organisations' that want to bid for public service contracts. A Public Service Reform White Paper is due next year.
There will be a far-reaching new ‘Right to Provide' for public sector workers who wish to take over the running of their services.
Some thoughts and considerations
The ‘Personalisation agenda' will require ‘information brokerage and advice' services to support informed decision-making. The required ‘information revolution' proposed by DH will, at least, put information onto the agenda and may lead to opportunities for ILCs/DLCs.
It has long been the case that the preventative aspects of community equipment has been a low priority in most authorities. But, prevention will be the new watchword in the public health agenda. Good advice will be paramount, but care may be needed to ensure that established services are not overtaken or overlooked as the new LA role develops.
The ‘right to provide' and resulting plurality of providers - plus increased ‘mainstreaming' of independent living products - will create new challenges, especially for services that are marginalised, or perceived to be expensive. The future looks most promising for entrepreneurial individuals and outward-looking organisations. The power of networking has never been so important and the need to collaborate and establish strong partnerships never more vital. ‘Stand alone' services would appear to be especially vulnerable, so it will be increasingly important to be proactive in Health and Well-being Boards and other decision-making bodies locally.
The following short ‘digest' summarises some relevant new policies. The history of the DLC movement is one of growth and reduction as governments and policies have come and gone. There is a lot of experience to draw on and lessons to be learnt from those services that have survived and grown over the decades.
Policy Digest Links
A Patient-centred NHS
Information Revolution sets out Government proposals about transforming the way information is accessed, collected, analysed, and used.
Healthwatch England - the new consumer champion within the Care Quality Commission (CQC). Local Healthwatch organisations will be funded by LAs.
National Health Outcomes Framework
Transparency in Outcomes - a framework for the NHS (Dec 2010) the first NHS Outcomes Framework against which the NHS Commissioning Board will be held to account from 2012/13. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_123138.pdf
Quality and Productivity - the Quality, Innovation, Productivity and Prevention (QIPP) programme aims to ensure that "each pound spent brings maximum benefit and quality of care to patients". http://www.dh.gov.uk/en/Healthcare/Qualityandproductivity/QIPPworkstreams/DH_115448
National Institute of Health and Clinical Excellence (NICE) - will be given a firmer statutory footing and will publish quality standards http://www.nice.org.uk/
Revolutionise NHS accountability
GP Consortia will be new statutory bodies. Governance will be assured through accountability structures and arrangements being put in place.
The NHS commissioning Board will be operational from April 2012. It will hold Consortia to account. The Secretary of State will retain overall accountability for the NHS and will set the mandate for the NHS.
Commissioning Decisions will focus on improving the quality and outcomes in care, incentivised through a ‘quality premium' scheme.
Promoting Better Public Health
Public Health Outcomes Framework
Covers five domains, all of which aim to reduce health inequalities:
1. Health Protection and Resilience
2. Tackling the wider determinants of health
3. Health Improvement
4. Prevention of ill health
5. Healthy life expectancy and preventable mortality
Health and Wellbeing Boards, in every LA, will lead on the strategic co-ordination of commissioning across sectors. They will produce Joint Strategic Needs Assessments (JSNA) to inform commissioning decisions and strategies to address them (Joint Health and Wellbeing Strategies - JHWS). http://www.dh.gov.uk/en/Publichealth/Healthyliveshealthypeople/index.htm
Adult Social Care
A Vision of Adult Social Care: Capable Communities and Active
Citizens Proposals for adult social care, put personalised services and outcomes centre stage.
Think Local, Act Personal, published in January 2011, is a sector-wide partnership agreement on delivering the outcomes framework for adult social care.
Recognised, valued, Supported: Next Steps for the Carers Strategy
The 4 priorities of the Carers' strategy are:
1. Identification and recognition
2. Realising and releasing potential
3. A life outside of caring
4. Supporting carers to stay healthy
Universal credit: welfare that works
There will be no automatic entitlement to the new Personal Independence Payment, other than special rules that apply for people who are terminally ill. Each case will be looked at individually, considering the impact of the impairment or health condition, rather than basing the decision on the health condition or impairment itself.
The Department for Work and Pensions (DWP) has put together a summary of how disabled people may be affected by current changes.
The Department for Work and Pensions (DWP) has commissioned an independent review of the Department's specialist disability employment programmes.
Practical approaches to provider and market development (November 2010) http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_121670.pdf
Right to Provide
Making Quality your Business - a guide to the right to provide (March 2011)
Maggie Winchcombe - Director, Years Ahead and Honorary Assist UK member
|Last Updated on Wednesday, 15 June 2011 12:09|
A Policy Digest: some information for local service providers April 2011
Written by Administrator
Wednesday, 15 June 2011 09:04