In July 2010 Andrew Lansley MP, the Secretary of State for Health, published his plans for NHS reform in the White Paper, Equality and Excellence: liberating the NHS. The Health and Social Care Bill, introduced in July 2011, completed its passage through the Houses of Parliament and was granted Royal Assent to become the Health and Social Care Bill in April 2012.
The Bill is seen as a crucial part of the Government’s vision to modernize the NHS so that it is built around patients, led by health professionals and focused on delivering world-class healthcare outcomes. However, some major strands such as choice and competition in the health service, and NHS Trusts achieving foundation Trust status, were already in progress under the previous government with a completion date, now agreed by the coalition Government, of 2014.
From the point of view of patients and the public, access to NHS services on the basis of need, not ability to pay, will continue. The reforms are intended to improve quality and efficiency by reforming the organisations that commission, regulate and support health and care services.
Section 75 of the Health and Social Care Act provides the regulations and requirements for the procurement of NHS services.
Overview of health and social care structures in the Health and Social Care Act 2012
Roles and responsibilities at a National level
Ministers and the Department of Health including Public Health England
The Secretary of State (SoS) will remain ultimately accountable for the NHS in England. However, instead of directly managing service providers and commissioners, the Secretary of State will set priorities for the NHS through a mandate for the NHS England. A new executive agency Public Health England will be the national body overseeing the public health system and will be accountable to the Secretary of State.
NHS England – formerly the NHS Commissioning Board
The NHS England, formed by the Health and Social Care Act, is an independent body and will play a fundamental role in the new NHS. NHS England will provide the top level commissioning and managerial guidance for the NHS in England, and will be responsible for authorising and overseeing Clinical Commissioning Groups (CCGs), who in turn will be responsible for commissioning local health services. NHS Enlgand is responsible for allocating resources and commissioning certain services such as primary care services and specialised services (Dermatology specialised services) which will have their own budgets.
The key Domain directors for dermatology are:
Director for Reducing Mortality (Domain 1) – Professor Sir Mike Richards
Director for Long-term Conditions (Domain 2) – Dr Martin McShane
Monitor’s core duty will be to protect and promote patients interests. It will licence providers of NHS services in England and exercise functions in three areas: regulating prices; enabling integration and ‘preventing anti-competitive behaviours’ protecting against anti – competitive behaviour; and supporting service continuity. Monitor will collect data from dermatology providers in order to design a suitable pricing methodology. Monitor will set prices in agreement with the NHS Commissioning Board and publish them as part of the National Tariff. The Act introduces important checks and balances, including the potential for appeals to the Competition Commission.
NHS Trust Development Authority (NDTA)
The NTDA will be established as a special health authority in April 2013. It will have responsibility for the performance management of NHS trusts and will support them in their bid to become foundation trusts, the assurance of clinical quality, governance and risk in NHS trusts.
Care Quality Commission (CQC) including Healthwatch England
CQC will continue to inspect your service against essential standards of safety and quality. It will carry out inspections in response to information that it receives about a provider, which will now come through CCGs and local HealthWatch and HealthWatch England as well as through existing channels, such as patient and service user feedback and complaints. Patients will be able to access more information about how dermatology services are performing, which will help them to choose the treatment that they need from a range of different providers (including from charity or independent sector providers, social enterprises). The CQC’s role is separate from that of Monitor as its focus is upon the quality of service provided. It will maintain its inspectorate role of all care services.
National Institute for Health and Care Excellence (NICE)
NICE will continue to provide independent advice and guidance to the NHS, and will maintain its role of assessing the clinical and financial viability of treatment and services but will extend its role to include social care.
Health and Social Care Information Centre
The Health and Social Care Information Centre will be the central point for information collected from the NHS and social care organisations in England.
Roles and responsibilities at a local level
Local authorities will be responsible for improving the health of their local populations by pulling together all of the work done by the NHS, social care, housing, environmental health, leisure and transport services. Local authorities will be required to appoint a Director of Public Health and publish annual reports to chart local progress in health improvement. It is therefore important that you forge relationships with them to influence how your local dermatology services are developed.
Clinical Commissioning groups (CCGs)
CCGs have been in operation across the country, in shadow form, since the bill was introduced in January 2011. All GP practices will have to become members of a CCG. Groups of GP Practices will work together with other professionals including hospital doctors and nurses in Clinical Commissioning Groups (CCGs) will assume financial responsibility of the NHS Budget (£80billion), and commissioning secondary care services. As you will be aware, Strategic Health Authorities (SHAs) and Primary Care Trusts (PCTs) who were previously in charge of the NHS Budget, will be abolished by April 2013. CCGs are required to seek approval from their local authorities via their Health and Wellbeing boards, and their respective Local Health Watch; and to obtain advice from people with ‘a broad range of professional expertise’, mainly clinical senates and clinical networks. You will therefore need to familiarise themselves with who your local CCGs are, in order to build effective professional working relationships.
Health and Wellbeing Boards (Part of local authorities)
Health and Wellbeing Boards will have a duty to encourage integrated commissioning between health, social care and public health by bring together representatives from each of these areas. They will provide a forum across these groups to discuss the future shape of services, building on their assessments of local health and care needs. Their tasks will include developing joint health and wellbeing strategies to inform local commissioning plans. Representation on these Boards must include: one local elected representative, a representative of both the CCG and the Local Healthwatch, a local authority director for adult social services and children’s services and a director of public health. These representatives will be able to influence and challenge commissioning decisions and promote integrated health and care. These boards will report to the local authority’s Health Overview and Scrutiny Committee.
Healthwatch England (Formerly Local Involvement Networks LINks)
Healthwatch England the new national statutory consumer champion for health and social care in England was launched on 1st October 2012. Local Healthwatch will act as a point of contact for individuals, community groups and voluntary organisations dealing with health and social care services. Along with the Health and Wellbeing Boards, Healthwatch England and Local Healthwatch will give patients a stronger voice by making patient involvement an integral part of the commissioning process. The BAD has developed some guidance about how dermatology departments can proactively involve and engage with their patients. Please note that local healthwatch organisations begin work in April 2013. Until then LINks continue to help shape services.
National Quality Board
The National Quality Board (NQB) has published its final report setting out how quality will be maintained and improved in the new health system.
The NQB brings together the national organisations across the health system responsible for quality including the Care Quality Commission, Monitor, the NHS Trust Development Authority, NICE, the General Medial Council, the Nursing and Midwifery Council, the NHS Commissioning Board, Public Health England and the Department of Health.
This report focuses predominantly on how the new system should prevent, identify and respond to serious failures in quality and provides a collective statement from NQB members as to:
1. The nature and place of quality in the new health system;
2. The distinct roles and responsibilities for quality of the different parts of the system;
3. How the different parts of the system should work together to share information and intelligence on quality and to ensure an aligned and coordinated system wide response in the event of a quality failure; and
4. The values and behaviours that all parts of the system will need to display in order to put the interests of patients and the public first and ahead of organisational interests.
Quality Surveillance Group
QSGs will be established between now and March 2013, ready to go live in the new system from April 2013. The NQB guidance includes an assurance process, which will be rolled out between January and March 2013, to ensure that the network of QSGs is ready to go live from April.
They should seek to reduce the burden of performance management and regulation on providers of services, by ensuring that supervisory, commissioning and regulatory bodies work in a more coordinated way. QSGs will be supported and facilitated by the NHS Commissioning Board’s 27 Area and four Regional Teams.