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8/6/2019 NHS Future Forum
1/31
NHSFutureForum
Summaryreportonproposed
changestotheNHS
ProfessorSteveFieldChairman
8/6/2019 NHS Future Forum
2/31
2
8/6/2019 NHS Future Forum
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Contents
Letter to thePrimeMinister,DeputyPrimeMinisterand
the Secretary of State for Health from the NHS Future
ForumChair
5
TheNHSFutureForumourroleandhowwelistened 14
TheNHSConstitution 19
Integrationandcollaboration 20
Thepublicshealth 22
ThefourcorethemesoftheNHSListeningExercise:
ChoiceandCompetition PublicAccountabilityandPatientInvolvement ClinicalAdviceandLeadership
Education
and
Training
24
26
28
29
Gettingthepaceofchangeright 30
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LettertothePrimeMinister,
DeputyPrimeMinisterandthe
SecretaryofStateforHealth
TheNHShasalwaysbeenthereforme.Ithastakencareofmeand
myfamilywheneverwehaveneededit.Ithasbeenahugeprivilege
toworkasadoctorintheNHSformyentirecareer.Iknowthatits
coreprinciplesandvaluesareasimportantnowastheywerewhenit
waslaunched.Theyhavebecomepartofthefabricofoursociety,
bindingtogetherthepeopleandcommunitiesthatitservesandthe
staffthatworkforit.
Ithas,therefore,beenagreatresponsibilitytoleadthisprocess.AsIhavelistened
overthelasteightweeksIhavedonesowiththeopeningwordsoftheNHS
Constitutionattheforefrontofmymind. Thepowerfulopeningstatement
constantlyremindedmeoftheseriousnessofthetaskweweresetand,more
fundamentally,ofwhattheNHSisstrivingtoachieveeverysingleday:
TheNHSbelongstothepeople.Itistheretoimproveourhealthandwellbeing,supportingustokeepmentallyandphysicallywell,togetbetterwhenweareilland,whenwecannotfullyrecover,tostayaswellaswecantotheendofourlives.Itworksatthelimitsofsciencebringingthehighestlevelsofhumanknowledgeandskilltosavelivesandimprovehealth.Ittouchesourlivesattimesofbasicneed,whencareandcompassionarewhatmattersmost.Theleveloftheengagementwehaveseeninjusteightweekshasbeenstaggering
andhighlightshowimportantthefutureoftheNHSistostaff,patients,citizensand
allthoseorganisationsthatcareaboutitssuccess.Over6,700peoplehaveattended
listeningeventswithmembersoftheNHSFutureForum,3,000commentshavebeen
postedonthewebsite,over25,000peoplehaveemailedusand600peoplehave
takenthetimetocompleteaquestionnaire.Iamclearthatthereasonpeoplehave
beensowillingtoenterintoameaningful,constructiveandinsightfuldialoguewith
usandwitheachotherisnotbecausetheydontbelievetheNHSneedstochange
butbecausetheywantanychangestobetherightonesandtofeelownershipof
them.
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BasedonwhatIhaveheard,mymessagestoyouare:
TheGovernmentsstatedaimofmaking improvement inqualityandhealthcareoutcomestheprimarypurposeofallNHS fundedcare isuniversallysupported.
However,duringourlistening,weheardgenuineanddeepseatedconcernsfrom
NHSstaff,patientsandthepublicwhichmustbeaddressedifthereformsareto
be progressed. If the substantial changes we propose are accepted by
Government,thenIbelievethattheresultingframeworkwillplacetheNHSina
strongpositiontomeetthisobjectiveandtacklethepressingchallenges inthe
yearsahead;
It is right that GPs should take responsibility for the health of their localpopulationsandthefinancialandqualityconsequencesoftheirclinicaldecisions
throughacomprehensivesystemofcommissioningconsortia.But, theycannot
andshouldnotdothisontheirownandmustberequiredtoobtainallrelevant
multiprofessionaladvicetoinformcommissioningdecisionsandtheredesignof
patientpathways;
Servicesmustchange inordertomeettheneedsof localpopulations.Thiswillrequire difficult decisions, especially about the location of some services and
hospitals. These decisions will need to be sensitively handled but must be
clinicallyled;
Theplaceofcompetition shouldbeasa tool for supportingchoice,promotingintegrationandimprovingquality.Itshouldneverbepursuedasanendinitself.
Monitors role in relation to promoting competition should be significantly
diluted;
Thedeclarationof nodecisionaboutme,withoutmemustbehardwired intoevery part of the system from the legislation through to each and every
encounterbetweenapatientandahealthcareprofessional;
TherehasbeentoomuchfocusondifferentpartsofthesystemGPs,hospitals,publichealthand insufficientattentiontohowtheyalljoinuptoprovidethe
integratedcarethatpatientsneed;
BecausetheNHSbelongstothepeopletheremustbetransparencyabouthowpublicmoney isspentandhowandwhydecisionsaremadeandtheoutcomes
beingachievedateverylevelofthesystem;and
The education and training of the healthcare workforce is the foundation onwhichtheNHSisbuiltandthesinglemostimportantthinginraisingstandardsof
care.Moretime isneededtogetthisright theeffectsofmistakesmadenow
willbefeltforageneration.
EverybodyagreesthatwhiletheNHShasimprovedoverthepasttenyears,itcant
standstill.TheNHSmustaddressthechallengesthatlieahead.Itmustcontinuously
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more.Instead,cliniciansaregoingtohavetomakesomedifficultdecisionsonhow
wespendthemoneymoreeffectivelyandimportantlyhownottospendmoneyon
treatmentsthatdontwork.
IhavebeenadoctorintheNHSsince1982andseentheNHSimproveoverthose
years.But,Ibelievethecurrentmodelofcarecannotbesustainedinthefuture.The
NHSoftodayismostlyabouttheprovisionofepisodictreatmentofillnessessuchas
cancerandcardiovasculardisease.Priorityhasbeenonacutehospitalsandproviding
effectiveinterventionsandtreatmentsforpeopleaffectedbythoselifethreatening
conditions.
IbelievethattheNHSmustchange.Itmustreassesstheoldmodelofhospitalbased
care.Ahighprioritynowneedstobegiventomeetingtheneedsoftheincreasing
numbersofolderpeople.Aspeoplegetolder,theywillrequiremoresupportfrom
boththeNHSandsocialcaretoenablethemtoliveindependentlyinthecommunity
foraslongaspossible.
TheNHSwillneedtomovefromfocusingontreatingpeoplewhentheyareacutely
illtofocusingonpreventionandsupportingselfcareaswell. Wewillneedtomove
resourcesawayfromhospitalssothatwecanprovidemorecareinthecommunity
andinpeopleshomes.Manypatientsandhealthcarestaffhavetoldusthatpriority
shouldbegiventoenablingmorepeopletohavetheirwishesgrantedtodieathome
ratherthaninhospital. Toprovidethischoiceforpeopleattheendoflifewill
requireanintegratedapproachinhealthandsocialcarewithgreaterinvolvementof
thethirdsector,includingthehospicemovement.Movingtothenewmodelwill
requireamuchmorecomprehensiveapproachthatimprovesthecoordinationof
servicesforpatientsandtheirrelatives.
Inprimarycareweneedtocontinuetoimproveaccesstoservices,reducevariations
intheirqualityandprovideadditionalservicesthathelptokeeppeopleoutof
hospital.GPs,theirprimarycareteams,socialcareprofessionalsandspecialistsmust
workmuchmorecloselytogetheraspartofextendedteamstoensurethatthecare
providediseffectivelycoordinated.Betterinformationsystemsandthe
developmentofmoreintegratedelectroniccarerecordswillbeamajorenabling
factorforthis.
Togiveclinicianslikemyselftheheadroomtoofferourpatientstheverybestcare
thatwecan,wearegoingtohavetodecidewheretodisinvest,howtobecome
moreefficient,wheretorootoutwasteandtargetourlimitedbudgetsonwherewe
candothemostgoodforthemoneyspent.Weneedtodothisnottoreducewhat
theNHSdoesbuttotakeadvantageofnewopportunitiesforhealthierandlonger
livesthatpreviousgenerationswouldneverhavethoughtpossible.And,weneedto
dothisinpartnershipwiththepatientsandcitizenswearetheretoserve.
Ifwearegoingtoseizetheseopportunitiestheremustbechange.Butanychange
mustbecarefullyguidedbytheenduringvaluesoftheNHS,assetoutinourNHS
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Constitution,andarelentlessfocusonpurposetheprovisionofhighqualitycare
andimprovedoutcomesforpatients.
ItwasencouragingtoreadinlastyearsWhitePaperthattheGovernmentmade
clearthatitwouldbuildonLordDarzisreviewoftheNHSandestablish
improvementinqualityandhealthcareoutcomesastheprimarypurposeofallNHS
fundedcare.Theimportantdefinitionofqualitythathisreportsetout(safety,
effectivenessandpatientexperience)hasbeenincorporatedintotheHealthand
SocialCareBill. TheGovernmenthassincesetoutapowerfulnewaccountability
frameworkfortheNHS,calledtheNHSOutcomesFramework,whichisdesignedtofocusthewholesystemfromtoptobottomontheoutcomesachievedforpatients.
Theseareimportantandpositivestepsforward.
Soifthereisagreementabouttheprinciplesandtheneedforchange,whathasgone
wrong?Atbest,theHealthandSocialCareBillhasreceivedlacklustresupportfrom
manystaffgroups,openhostilityfromothersandhasbeenlambastedinmuchof
thepress.Thisoppositionwasnotmerelypoliticalitstemmedfromgenuinefear
andanxietythatthereformswouldnotdelivertheimprovementsthatweallwant.
Thisfearandmistrustwasexpressedbymanypatientsandstaffthatwemet.Many
toldusthattheyfearedfortheirownjobprospects,othersbecausetheyfearedthat
theirNHSwasabouttobebrokenupandintheirwordsprivatised.
SomeofthisfearwasmisplacedandtheresultofafailurebytheGovernmentto
clearlyexplainhowthestructuralandtechnicaldetailsoftheBillwouldhelptheNHS
improvetodayandtomorrow.Undoubtedly,thedebatehasfocusedtooheavilyon
themeans,withoutaclearenoughlinktotheendstheprovisionofhighquality
careandimprovedoutcomesforpatients.
However,inotherareaswefoundpeoplesconcernstobejustified.Whilsttherewas
neveranyintentiontointroduceamarketinthestyleoftheutilitiessectorinto
healthcare,theBillcontainedinsufficientsafeguardsagainstcherrypickingandwas
notsufficientlyclearthatcompetitionwouldonlyexistwhenitservedtheinterests
ofpatientsnotprofit.Inotherareas,whilstNHSstaffsupportedthegeneralthrustof
thereforms,theywereanxiousthatthedeadlineswouldforcethemtotakeon
responsibilitiesbeforetheyhadtheskillsorcapacitytoundertaketheminawaythat
wouldimprovepatientcare.And,inafewareas,suchastheproposalsforeducationandworkforcetraining,thereweregenuineconcernsthattherewassimplynot
enoughevidenceordetailtojustifysuchradicalchangewheretheconsequencesof
failurearesosignificantandlonglasting.
So,intakingforwardourtask,wehavedoneonesimplething:wehavetakenthe
keybuildingblocksofthereformprogrammeandlookedatthemthroughthelensof
whethertheywillhelporhinderthedeliveryofhighqualitycareandimproved
outcomesforpatients.Wherewehaveidentifiedweaknessesinthelegislative
frameworkorbroaderpolicy,wehaverecommendedchanges.Wheretherehas
been
failure
to
explain,
we
have
sought
to
provide
clarifications
about
the
purpose
aswellasthemechanismsintheBill.Wheretherehasbeengenuineanxietyand
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mistrust,wearerecommendingsafeguardsfortheavoidanceofdoubt.And,where
thecaseforchangehasyettobeproven,wehaverecommendedthatfurtherwork
becarriedout.Atalltimes,thepursuitofhighqualitycareandimprovedoutcomes
forpatientshasguidedusinourrecommendationsandmustbetheguidingprinciple
foranychange,whetheratanationalorlocallevel.
Itwasrighttopauseandreflect.Ithas,however,beenadestabilisingperiodforthe
NHSandanunsettlingtimeforstaffandforpatients.Itistimeforthepausetoend.I
believethattheadviceandrecommendationswepresentinthisreport,ifacted
upon,willhelptheNHStomoveforwardandrefocusitseffortsondelivering
excellenceinpatientcareandbuildingtheNHSofthefuture. Thecore
recommendationsofthefullNHSFutureForumare:
TheenduringvaluesoftheNHSandtherightsofpatientsandcitizensassetoutintheNHSConstitutionareuniversallysupportedandshouldbeprotectedand
promotedatalltimes.TheBillshouldbeamendedtoplaceanewdutyonthe
NHSCommissioningBoardandcommissioningconsortiatoactivelypromotethe
NHSConstitution.Inaddition,Monitor,theCareQualityCommission,theNHS
CommissioningBoardandcommissioningconsortiashouldallsetouthowthey
aremeetingtheirdutytohaveregardtotheNHSConstitutionintheirannual
reports.
TheNHSshouldbefreedfromdaytodaypoliticalinterferencebuttheSecretaryofStatemustremainultimatelyaccountablefortheNationalHealth
Service.TheBillshouldbeamendedtomakethisclear.
Patientsandcarerswanttobeequalpartnerswithhealthcareprofessionalsindiscussionsanddecisionsabouttheirhealthandcare.Citizenswanttheir
involvementindecisionsaboutthedesignoftheirlocalhealthservicestobe
genuine,authenticandmeaningful.Therecanbenoplacefortokenismor
paternalism. Thedeclarationofnodecisionaboutme,withoutmemust
becomeareality,supportedbystrongerandclearerdutiesofinvolvement
writtenintotheBillfocusedontheprinciplesofshareddecisionmaking.
BecausetheNHSbelongstothepeopletheremustbetransparencyabouthowpublicmoneyisspentandhowandwhydecisionsaremade.TheBill
shouldrequirecommissioningconsortiatohaveagoverningbodythatmeetsin
publicwitheffectiveindependentrepresentationtoprotectagainstconflictsof
interest.MembersofthegoverningbodyshouldabidebytheNolanprinciplesof
publiclife.AllcommissionersandsignificantprovidersofNHSfundedservices,
includingNHSFoundationTrusts,shouldberequired,asaminimum,topublish
boardpapersandminutesandholdtheirboardmeetingsinpublic.Foundation
Trustgovernorsmustbegivenappropriatetrainingandsupporttooverseetheir
Trustsperformanceuntilgovernorshavethenecessaryskillsandcapabilityto
takeonthisroleeffectively,Monitorscomplianceroleshouldcontinue.
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GPs,specialistdoctors,nurses,alliedhealthprofessionalsandallotherhealth
andcareprofessionalsstatethattheremustbeeffectivemultiprofessional
involvementinthedesignandcommissioningofservicesworkingin
partnershipwithmanagers.Arrangementsformultiprofessionalinvolvementin
thedesignandcommissioningofservicesareneededateverylevelofthe
system.TheBillshouldrequirecommissioningconsortiatoobtainallrelevant
multiprofessionaladvicetoinformcommissioningdecisionsandthe
authorisationandannualassessmentprocessshouldbeusedtoassurethis.In
supportofthis,thereshouldbeastrongroleforclinicalandprofessional
networksinthenewsystemandmultispecialityclinicalsenatesshouldbe
establishedtoprovidestrategicadvicetolocalcommissioningconsortia,health
andwellbeingboardsandtheNHSCommissioningBoard.
Managershaveacriticalroletoplayinworkingwithandsupportingcliniciansandclinicalleaders.Experiencedmanagersmustberetainedinordertoensurea
smoothtransitionandsupportclinicalleadersintacklingthefinancialchallenges
facingtheNHS.
Thereshouldbeacomprehensivesystemofcommissioningconsortiabuttheyshouldonlytakeontheirfullrangeofresponsibilitieswhentheycan
demonstratethattheyhavetherightskills,capacityandcapabilitytodoso.
Theassessmentoftheskills,capacityandcapabilityofcommissioningconsortia
mustbeplacedattheheartofauthorisationandannualassessmentprocess.
Wherecommissioningconsortiaarenotready,theNHSCommissioningBoard
shouldcommissionontheirbehalfbutprovideallnecessarysupporttoenable
thetransferofpowertotakeplaceassoonaspossible.
Patientswanttohaverealchoiceandcontrolovertheircarethatextendswellbeyondjustchoiceofprovider. BuildingontheNHSConstitution,theSecretary
ofStateshould,followingfullpublicconsultation,giveachoicemandatetothe
NHSCommissioningBoardsettingouttheparametersforchoiceandcompetition
inallpartsoftheservice.ACitizensPanel,aspartofHealthwatchEngland,
shouldreporttoParliamentonhowwellthemandatehasbeenimplemented
andfurtherworkshouldbedonetogivecitizensanewRighttoChallengepoor
qualityservicesandlackofchoice.
Competitionshouldbeusedasatoolforsupportingchoice,promotingintegrationandimprovingqualityandmustneverbepursuedasanendin
itself.Monitorsroleinrelationtocompetitionshouldbesignificantlydilutedin
theBill.Itsprimarydutytopromotecompetitionshouldberemovedandthe
BillshouldbeamendedtorequireMonitortosupportchoice,collaborationand
integration.
PrivateprovidersshouldnotbeallowedtocherrypickpatientsandtheGovernmentshouldnotseektoincreasetheroleoftheprivatesectorasanend
initself.Additionalsafeguardsshouldbebroughtforward.
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ThedutiesplacedontheSecretaryofState,theNHSCommissioningBoardand
commissioningconsortiatoreducehealthinequalitiesarewelcome.Thesenow
needtobetranslatedintopracticalaction.TheMandatefortheNHS
CommissioningBoard,theoutcomesframeworksfortheNHS,publichealthand
socialcare,commissioningplansandothersystemleversandincentivesmustall
beusedtohelpreducehealthinequalitiesandimprovethehealthofthemost
vulnerable.
LocalgovernmentandNHSstaffseehugepotentialinhealthandwellbeingboardsbecomingthegeneratorsofhealthandsocialcareintegrationandin
ensuringtheneedsoflocalpopulationsandvulnerablepeoplearemet.The
legislationshouldstrengthentheroleandinfluenceofhealthandwellbeing
boardsinthisrespect,givingthemstrongerpowerstorequirecommissionersof
bothlocalNHSandsocialcareservicestoaccountiftheircommissioningplans
arenotinlinewiththejointhealthandwellbeingstrategy.
Betterintegrationofcommissioningacrosshealthandsocialcareshouldbetheambitionforalllocalareas.Tosupportthesystemtomakeprogresstowards
this,theboundariesoflocalcommissioningconsortiashouldnotnormallycross
thoseoflocalauthorities,withanydepartureneedingtobeclearlyjustified.The
GovernmentandtheNHSCommissioningBoardshouldenableasetofjoint
commissioningdemonstrationsitesbetweenhealth,socialcareandpublichealth
andevaluatetheireffectiveness.
MostNHSstaffareunfamiliarwiththeGovernmentsproposedchangestotheeducationandtrainingofthehealthcareworkforce.Thosewhoareawarefeel
thatmuchmoretimeisneededtoworkthroughthedetail.Theultimateaim
shouldbetohaveamultidisciplinaryandinterprofessionalsystemdrivenby
employers.Therolesofthepostgraduatemedicaldeaneriesmustbepreserved
andaninterimhomewithintheNHSfoundurgently.Theprofessional
developmentofallstaffprovidingNHSfundedservicesiscriticaltothedelivery
ofsafe,highqualitycarebutisnotbeingtakenseriouslyenough.TheNational
QualityBoardshouldurgentlyexaminehowthesituationcanbeimprovedand
theconstitutionalpledgeto'provideallstaffwithpersonaldevelopment,access
toappropriatetrainingfortheirjobsandlinemanagementsupporttosucceed'
behonoured. Improvingthepublic'shealthiseveryone'sbusinessbutshouldbesupported
byindependent,expertpublichealthadviceateverylevelofthesystem.In
ordertoensureacoherentsystemwideapproachtoimprovingandprotecting
thepublic'shealth,alllocalauthorities,healthandsocialcarebodies(including
NHSfundedproviders)mustcooperate.Atanationallevel,toensurethe
provisionofindependentscientificadvicetothepublicandtheGovernmentis
notcompromisedweadviseagainstestablishingPublicHealthEnglandfully
withintheDepartmentofHealth.
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Clinicalleaders,managersandallthosewhocareaboutthesuccessoftheNHS
agreethatquality,safetyandmeetingthefinancialchallengemusttake
primacyandthepaceoftransitionshouldreflectthis.Toensurefocused
leadershipforquality,safetyandthefinancialchallenge,theNHSCommissioning
Boardshouldbeestablishedassoonaspossible.
Iwouldliketothankthethousandsofindividualsandorganisationsthathavemade
theircontributiontotheworkoftheNHSFutureForum,andtothe44membersof
theForumitself.Withouttheirgenuinecommitmentandserioushardwork,itwould
nothavebeenpossibletowritethisreport.
ItisnowtimetomoveonbuttheactivelisteningmustcontinuetheNHSFuture
Forumstandsreadytohelplistenandtoadvise.
ProfessorSteveFieldCBEFRCGPFRCP
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TheNHSFutureForum
ourroleandhowwelistened
Introduction
On6April,theGovernmentannouncedthatitwouldtakeadvantageofanatural
breakinthelegislativetimetabletopause,listenandreflectonmodernisation
plansandbringaboutimprovementstotheHealthandSocialCareBillwhere
necessary.
AneightweekNHSListeningExercisewasannounced.Theobjectivewasnotto
repeattheformalpublicconsultationswhichhadalreadytakenplace,buttoreflect
ontheareaswhichhadpromptedthemostheateddiscussionanddebateandbring
forwardimprovementstothelegislationwherenecessary.Thefourcorethemesof
theNHSListeningExercisewere:
Choiceandcompetition Clinicaladviceandleadership Patientinvolvementandpublicaccountability EducationandtrainingThe
NHS
FutureForum
TheNHSFutureForumwasestablishedasanindependentadvisorypaneltodrive
engagementaroundthelisteningexercise,listentopeoplesconcerns,reportback
onwhatweheardandofferadvicetothePrimeMinister,DeputyPrimeMinisterand
theSecretaryofStateforHealthonhowtheGovernmentsmodernisationplansfor
theNHSmightbeimproved.
TheForum,chairedbyProfessorSteveFieldimmediatepastChairmanoftheRoyal
CollegeofGPs,bringstogether45individualsfromadiverserangeofbackgrounds
including
frontline
clinicians,
healthcare
managers
and
representatives
from
the
voluntarysector,localgovernmentandpatientbodiesamongstothers.
AsaForumwedividedourselvesintofourworkinggroupstotackleeachofthecore
themesandcommittedtoundertakeanintensiveperiodoflisteningandreflection.
Eachofthesegroupswasledbyaworkstreamlead:
SirStephenBubb,leadforChoiceandCompetition(ChiefExecutiveoftheAssociationofChiefExecutivesofVoluntaryOrganisations)
DrKathyMcLean,leadforClinicalAdviceandLeadership(MedicalDirectorofNHSEastMidlands)
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JulieMoore,leadforEducationandTraining(ChiefExecutiveofUniversity
HospitalsBirmingham)
GeoffAlltimes,leadforPatientInvolvementandPublicAccountability(ChiefExecutiveofHammersmithandFulhamBoroughCouncil)
Thetimescalesforthelisteningperiodweretightandchallengingwithmanyofus
workingfulltime,includingmanyaspractisingclinicians.However,weworkedasa
grouptomaximisetheengagementopportunitiespresentedtous.Wealso
mobilisedexistingnetworks,eventsandusednewwaysofengagementsuchas
webchatsandblogstoreachkeyaudiences.
Wecametogetherasawholeatregularintervalstoshareandcrossreferencekey
themescomingoutoftheexerciseandworkedtogethertodevelopour
recommendations.
LordVictorAdebowale,ChiefExecutive,TurningPoint DrCharlesAlessi,SeniorGPPartner,TheChurchillPractice GeoffAlltimes,ChiefExecutive,LondonBoroughof
HammersmithandFulham
DrFrankAtherton,President,AssociationofDirectorsofPublicHealth
VickyBailey,ChiefOperatingOfficer,Principia,PartnersinHealth,Nottingham
SallyBrearley,Patientrepresentative SheilaBremner,ChiefExecutive,MidEssexPrimaryCare
Trust
DrSimonBrown,HuntingtonGPConsortiapathfinderlead SirStephenBubb,ChiefExecutive,AssociationofChiefExecutivesofVoluntaryOrganisations
ProfessorHilaryChapman,ChiefNurse,SheffieldTeachingHospitals
hiefExecutive,RaceEqualityFoundationRatnaDutt,C ofCamdenMoiraGibb,ChiefExecutive,LondonBorough ,MarkGoldring ChiefExecutive,Mencap
sultantUrologicalSurgeon,Royalers
Associationof Hallett,ChiefExecutive,MarieCurie vidKerr,ProfessorofCancerMedicine,Oxford ,IntensiveCareNurse,Imperial tt,ConsultantPsychiatrist,OxleasNHS
ChrisLong,ChiefExecutive,HullPCT
ChiefExecutive,Brighton&SussexUniversity
OrthopaedicSurgeonandCo
;andChair,Lambeth
Professor
son,President,Royal irJohnTooke,ViceProvost,University ofMidwifery,PortsmouthHospitalsNHS
PaulFarmer, ChiefExecutive, MindMrDerekFawcett,ConBerkshireNHSFoundationTrust
ProfessorDavidFish,ManagingDirector,UCLPartnPeterHay,Strategic
Director,AdultsandCommunities,
BirminghamCityCouncil;andVicePresident,DirectorsofAdultSocialServices
ThomasHughesCancerCare
Prof.DaUniversity
JoannaKillian,ChiefExecutive,EssexCountyCouncilClareLeonVillapalosCollegeHealthcareNHSTrustDrPaulLellioFoundationTrust
MalcolmLoweLauri,ChiefExecutive, UniversityHospitalsofLeicesterNHSTrust
BillMcCarthy,ChiefExecutive, YorkshireandHumberStrategicHealthAuthority
ClaireMarshall,HeadofProfessions,HeatherwoodandWexhamParkHospitalsNHSFoundationTrust
AnthonyMcKeever,ChiefExecutive,BexleyCareTrust DrKathyMcLean,MedicalDirector,NHSEastMidlands JulieMoore,ChiefExecutive,UniversityHospitals
stBirminghamNHSFoundationTru
DrPeterNightingale,President,RoyalCollegeofAnaesthetists
MrDermotORiordan,MedicalDirectorandConsultantolkHospitalNHSTrustSurgeon,WestSuff
DrNitiPall,PractisingGP,Smethwick;ChairandClinicalLead,epathfinderconsortiaWestMidlandsThirdWav
ecutive,LeedsCityCouncilTomRiordan,ChiefEx Cllr.DavidRogers,Chair,LocalGovernmentAssociation
CommunityHealthandWellbeingBoard
DuncanSelbie,HospitalsTrust
MrMatthewShaw,founder,RemedyUK
AshSoni,Pharmacist,LambethProfessionalExecutiveCommittee
ProfessorJimmySteele,HeadofSchoolandofOralHealthServicesResearch,NewcastleUniversity
ProfessorTerenceStephenCollegeofPaediatricsandChildHealth
JeremyTaylor,ChiefExecutive,NationalVoicesProfessorSCollegeLondon
DrRobertVarnam,PractisingGP,ManchesterGillWalton, DirectorTrust
MrFrancisWells, diothoracicSurgeon,PapworthHospitalNHSFoundationTrust
ConsultantCar
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NHSFutureForumMembers
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Howwelistened
Facetofacelisteningwemetwithalargenumberofpeoplefacetofacetohear
firsthandviews,concernsandsolutionsofpatients,thepublic,NHSstaffand
stakeholders.
In
total,
we
met
with
over
6,700
people
in
a
series
of
over
200
listening
eventsandmeetings.Thesemeetingsandeventsincluded:
Meetingsandeventswithover250nationalstakeholderorganisationsthroughproactiveengagement,anumberofnationalstakeholdersofferedto
hostorreviseexistingagendastoaccommodatelisteningeventswiththeir
membersandrepresentativesinordertofeedtheirviewsintothelistening
exercise.Theseorganisationsincludedpatientgroups,professionalbodies
andunions,thirdsectorgroups,aswellaslocalgovernment,regulatorsand
theindependentsector.
Regionallisteningeventsandmeetings StrategicHealthAuthorities(SHAs)acrossthecountrysupportedthelisteningexercisebyencouragingstaff,
communitiesandstakeholdersatregionalandlocallevelstosharetheir
viewsonline.Furthermore,theSHAsusedseveralhundredeventsand
meetingstoengagepeopleintheexercise.Weattendedanumberofthese
meetingsacrossthecountryandthethemesfromthemeetingswerecollated
regionallyandthensharedwiththeForum.
PatientandpublicengagementmembersofLocalInvolvementNetworks(LINks)wereinvitedtotwonationallisteningeventswiththeForumtofeedinviewsfromtheircommunities.Furthermore,regionalrepresentativesfrom
patientorganisations,thethirdsectorandLINkswereinvitedtoaseriesof
nineregionaleventshostedbyRegionalVoices.Over100patientsand
patientrepresentativeswithlongtermconditionswerealsoinvitedtoa
nationalpatienteventhostedbyRethink.
Onlineengagement
PeoplewereencouragedtosharetheirviewswiththeNHSFutureForumina
numberofwaysincluding:
WebchatswetookpartinaseriesofwebchatswiththepublicthroughtheDepartmentofHealthmodernisationsite,theGuardiansiteandtheBritish
MedicalAssociationsite.
Commentsviathemodernisationwebsitemembersofthepublicandstakeholderswereinvitedtoleavecommentseitherpubliclyorprivatelyvia
themodernisationwebsite.Morethan3,000commentswerereceived
throughthewebsite.
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NHSFutureForuminboxmembersofthepublicandstakeholderswere
alsoinvitedtoemailcommentsandviewpointsviaadedicatedinboxifthey
preferred,whichweresharedwiththeForum.Over25,000emailswere
receivedand600peopletookthetimetocompleteaquestionnaire.Itis
importanttopointoutthatalargeproportionoftheseemailswere
generatedbycampaigngroupsandthatasaresult,manyofthemcontained
similarwording.Nonetheless,ourapproachisthatifanindividualseesfitto
takepartinsuchcampaigns,theiremailisfullyconsidered.
Socialnetworks manyofusalsomadeuseofsocialnetworkroutessuchasTwittertopromotewaystogetinvolved.
TheNHSFutureForumisverygratefultothethousandsofpeoplewhotookthetime
totalktousandtosubmittheirviews.
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Integrationandcollaboration
OneofthewaystheNHScandelivercarethatupholdstheprinciplesandvaluesof
theNHSConstitutionisincreasedintegrationofcarearoundtheneedsofthepatient.Thiswasacorethemeinmanyofourdiscussions.
TheGovernmentsproposalsfortheNHShaveattractedmanyclaimsthattheywill
createfragmentationandundermineintegrationofservicesaroundtheneedsof
patientsandindividuals.Whatisalsoclearisthatservicesundertheexistingsystem
arecurrentlyhighlyfragmentedacrosstheNHS,publichealthandsocialcare;and
withintheNHS,betweenprimary,secondaryandtertiarycare.Regardlessof
whetherourdiscussionswerefocussedontheissueofpublicaccountabilityand
patientinvolvement,competitionandchoiceorclinicaladviceandleadership,
concerns
around
integration
came
up
time
and
time
again.
The
importance
of
collaborationandintegrationbetweendifferentcaresectorsandcaresettingsare,
therefore,strongthemesineachoftheseparateworkstreamreportsandimportant
recommendationsforstrengtheningcollaborationandintegrationareputforward.
Therearealreadyexamplesofsuccessfulintegrationofhealthandsocialcareat
differentlevelsintheNHS.Whiletherearemanyexamplesinlocalcommunitiesof
multidisciplinaryteamsworkingtogethertomeettheneedsofindividualpatients
andcarers,therearealsoexamplesofintegratedservicesatalargerscalefor
exampleinstrokecareinLondon,diabetesinBoltonandinthecareofolderpeople
inTorbay.Wehavelearntthatitdoesntalwaysneedamergerofservicestodeliver
bettercarebutprovidersworkingtogether,forexample,innetworkstocoordinate
aroundtheneedsofpatients.
However,legislatingordictatingforcollaborationandintegrationcanonlytakeusso
far.Formalstructuresarealltoooftenpresentedasanexcuseforfragmentedcare.
Therealityisthattheprovisionofintegratedservicesaroundtheneedsofpatients
occurswhentherightvaluesandbehavioursareallowedtoprevailandthereisthe
willtodosomethingdifferent.Weneedtomovebeyondarguingforintegrationto
makingithappen,whilstexploringthebarriers.Wewouldthereforeexpecttosee
theNHSCommissioningBoardactivelysupportingthecommissioningofintegrated
packagesofcarebuildingontheideasthatmanyorganisations,includingtheKings
FundandtheNuffieldTrust,havepresentedaspartoftheListeningExercise.
Wehaveseenthatmanylocalareasacrossthecountryarepressingaheadwith
strengthenedpartnershiparrangements. Morethanfourineveryfiveuppertier
localauthoritiesinEnglandareearlyimplementersforGovernmentsproposed
healthandwellbeingboards.Thisdemonstratesenthusiasmfromcouncilsandtheir
NHSpartnerstoworktogethertoimprovehealthandcareoutcomesforlocal
communities.Theseearlyimplementershavetoldustheyseethisasanopportunity
toovercomehistoricalblockstoinnovation,buildingbetterservicesthatarejoined
uparoundtheneedsoflocalpeopleandcommunities,toaddresshealthinequalities
andtotacklethewiderdeterminantsofhealth. Thereappearstobeagrowing
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consensusthathealthandwellbeingboardshavethepotentialtoprovidean
opportunityforlocalpartnerstoworkwithcommunitiesandtodeliverrealbenefits
inawaythattheyhaventbeenabletoachieveunderpreviousarrangements.
Wehavealsoheardofmanyexamplesofcommissioningconsortiapathfinders
testingoutthenewcommissioningarrangementsanddemonstratinghowclinical
leadershipofcommissioningcanimprovecare,reducewasteanddeliverbetter
outcomesandvalue. Manypathfindershavehighlightedthebenefitsofstronger
collaboration,bethatbetweenprimaryandsecondarycare,orlocalpartnership
workingwithlocalauthorities,butalsotheimportanceofengagementwithpatients
andthepublic. BassetlawCommissioningOrganisationisworkinginpartnership
withitslocalNHSFoundationTrusttoimproveacutecareprocessesanddischarge
systemtoimprovepatientcare. IntegratedCareCommissioning,apathfinderin
SouthBirmingham,issettinguppartnershipswithlocalauthorityandthirdsector
organisationstodelivernewservicesforpatients.Othersarelookingatreferral
managementthroughpeerreview. Whatisclearisthattheyareallfocusedonreally
makingadifferencefortheirpatients.
Collaborationisessentialforeffectiveclinicalnetworksandthedeliveryofhigh
qualityeducation,trainingandresearch.Itisalsothemostclinicallyandcost
effectivewayofdeliveringhighqualitycareforthosechildrenandadultswithco
morbiditiesandlongtermconditions.Inshort,collaborationisessentialforthe
deliveryofhighqualityhealthandcareinthefutureNHS.
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Atanationallevel,weheardaboutthevalueofastrong,integratedpublichealth
serviceencompassingthethreedomainsofpublichealth:healthprotection,health
improvementandhealthservices.But,wealsoheardstrongconcernsfromthe
publichealthcommunitythattheorganisationalformshouldnotcompromisethe
abilitytoprovideindependentscientificadvicetothepublicandtheGovernment.
WearenotconvincedthatthecurrentproposalstoplacePublicHealthEnglandfully
withintheDepartmentofHealthwillachievethenecessarylevelofindependence
and,withthat,publictrustandconfidence.Wethereforerecommendagainstthis.
RegardlessofthefinalorganisationalformofPublicHealthEngland,itwillbevitalfor
ittoworkcloselywiththeNHSCommissioningBoardinordertoeffectivelydeliver
againstallthreedomainsofpublichealth.
TheGovernmentsfocusoninclusionhealthandreducinghealthinequalitieshasalso
beenwarmlywelcomed.ThedutiestheBillalreadyplacesontheSecretaryofState,
theNHSCommissioningBoardandcommissioningconsortiawillallneedtranslating
intopracticalactionthroughthemandate,theoutcomesframeworksfortheNHS,
publichealthandsocialcare,commissioningplansandothersystemleversinorder
toreducehealthinequalitiesandimprovethehealthofthemostvulnerable.
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ThefourcorethemesoftheNHS
ListeningExercise
ChoiceandCompetition
Choiceandcompetitionhasprobablybeenthemostcontroversialareaofthe
Forumsworkandhaspromptedverystrongviews. Forsome,theGovernments
proposalsrepresentanattackonthecorevaluesoftheNHS. Forothers,theyare
theonlymeansofensuringthattheNHScanbeprotectedandsustainedintothe
future. Itisunfortunatethatmuchofthepublicdebatehasbecomepolarised
aroundthesepositionsandtheChoiceandCompetitiongroupsoughttomove
beyondtheseextremestohearwhatpeoplesviewswereabouttheimpactthatchoiceandcompetitionwouldhaveintheNHS.
Whilsttherewereawidevarietyofdiscussions,thereweresomethemesthatcame
uptimeandtimeagain:WhatdoeschoiceactuallymeanintheNHS? WhereandwhenshouldcompetitionbeappliedintheNHS? WhatroleshouldtheprivatesectorhaveintheNHS?InlookingatwhatchoiceintheNHSmeans,theForumisclearthat,inlinewiththe
NHSConstitution,choicemustbemorethanjustchoiceofprovider. Severalofthe
responses
we
received
through
the
website
commented
that
people
were
more
worriedaboutthequalityandsafetyoflocalservicesthanbeingabletochoose
wheretogo.
Itisabsolutelyrightthatpeopleshouldhavetheconfidencethattheirlocalservices
aresafe. But,weareclearthatchoicecanhelpsupportbetterqualityandmore
integrationbetweenhealthandsocialcare. Itisalsotruethatchoiceofwheretogo
isnotalwaysrelevant,forexampleinanemergencytheparamedicswillnot
normallybeabletoaskyouwhereyouwanttogo.However,thatshouldnotmean
thatsomeoneshouldnothavechoicearoundtheirtreatment. Thereisastronglink
herewiththereportonPatientInvolvementandPublicAccountabilityasmore
choiceispartoftheshareddecisionmakingethos.
Therearepartsofthesystemthatareofferingpeoplechoicenow,butmoreneeds
tobedonetodeliverrealchoice. Wethereforerecommendthatthereshouldbea
clearerchoiceoffer,setoutinachoicemandateasacorepartoftheoverall
mandatethattheHealthandSocialCareBillsaystheSecretaryofStateshouldgive
totheNHSCommissioningBoard. Allplayersinthesystemshouldthenbeheldto
accountfordeliveringthisoffer. Wealsorecommendastrongerpushtooffer
personalhealthbudgetswheretheseareappropriate.
Perhapsthemostcommonlydiscussedissuewaswhatthepracticalimplicationsof
theBillwereforcompetitionintheNHS.Therewasagreatdealofconfusionabout
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whereandwhenitwouldbeapplied,andfearsthatcompetitioncouldblock
attemptstointegratecarearoundthepatient,andthatMonitorwouldapply
competitionlawtopromotecompetitionabovepatientcare.Competitionalready
existsinthehealthservice,andtheForumisconvincedthatithasaplaceinenabling
choiceandimprovingquality.But,itwillnotbeappropriateeverywhere. The
currentpolicyisnotclearenoughaboutthis. Wehaveheardmanypeoplesaying
thatcompetitionandintegrationareopposingforces. Webelievethisisafalse
dichotomy. Integratedcareisvital,andcompetitioncanandshouldbeusedby
commissionersasapowerfultooltodrivethisforpatients.
Thereneedtobechangestothecurrentplanstoputstrongersafeguardsinplace
againstthemisuseofcompetition.And,theremustbemuchgreaterclarityonwhere
competitionwouldbeapplied. Mostimportantly,theBillshouldbechangedtobe
veryclearthatMonitorsprimarydutyisnottopromotecompetition,buttoensure
thebestcareforpatients.Aspartofthis,theymustsupportthedeliveryof
integratedcare.
ThereportalsorecommendsthatthereshouldthisinstitutionaldutyonMonitorto
promotecompetitionisreplacedwithanewrightforpatientstherightto
challengecommissionersatlocallevelwheretheyfeelthatchoicedoesnotexistand
wheretheyfeelthatservicesarenotgoodenough.Furtherpolicyworkisneededto
ensurethisrighttochallengewillleadtorealchange,drivenbypatientsandcitizens.
TheForumheardrealconcernsabouttheinvolvementoftheprivatesectorand
whethertheNHSwasbeingprivatised. Itisclearthatpeoplearegenuinelyworried
thatpoliciessuchasAnyQualifiedProviderwillallowtheprivatesectortoget
involvedinlargepartsoftheNHS. Thisfearoverlooksthefactthatcharitiesandthe
voluntarysectorwillalsobeabletotakeadvantageofAnyQualifiedProviderandit
couldallowsmallerlocalorganisationstoofferservicesthattrulyreflecttheir
communitiesneeds. Thereneedstobeawayofenablingnew,innovativeservices
thatwillofferwhatthepatientneeds.But,theForumisveryclearthattheNHS
shouldnotbeprivatised.
Peoplewereworriedthattheprivatesectorwillcomeinandcherrypickprofitable,
lowriskpatients,leavingthecomplexandexpensivepatientstoNHSservices. This
couldpotentiallymeanthattheNHSorganisationcouldfindthatsomeclinical
servicesbecameunviable.Itisclearthatmoreneedstobedonetoensurethat
cherrypickingdoesnotunderminethequalityofservicesthatpatientshaveaccess
tolocally.
AsthefullreportonChoiceandCompetitionconcludes,ifcompetitionisused
effectivelyandproperlyregulated,wedonotbelieveitthreatensthefundamental
principleofanNHSthatisuniversalandfreeatpointofdelivery.Thereversemay
wellbetrue;thatithelpsprotectthatintothefuture. Therecommendationsfrom
thisworkstreamareintendedtohelpmovethedebatefromwhetherornot
competitionworkstohowbesttomaximisethebenefitswhilstminimisingtherisks.
Readthefullreportofthechoiceandcompetitiongroupatwww.dh.gov.uk/nhsfutureforum
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Wealsoheardhowpatientandpublicinvolvementinthedesignofcarepathways
andstrategiccommissioningdecisionsateverylevelwascriticalforpeople. Health
andwellbeingboardsmusthaveakeyroletoplayinpromotingthislocally.Wealso
recommendthatthereshouldbeindependentrepresentationoncommissioning
consortiagoverningbodieswithspecificresponsibilityforensuringthattheirdutyto
involveiseffectivelyfulfilled.
TheForumalsoheardconcernsaboutwhetherthenewsystemwouldhavethe
appropriateaccountabilitymechanismsatlocalandnationallevels,andsufficient
safeguardsagainstconflictsofinterest.Althoughmanywelcomedtheconceptofthe
healthandwellbeingboard,theywerealsodisappointedatthelackofpowergiven
totheseboardstodrivecooperationandintegrationofservicesatalocallevelandin
theinterestsoflocalpopulations.
Wefirmlybelieveinthepotentialofhealthandwellbeingboardsandhaveoutlined
ourvisionthattheyarethefocalpointforlocaldecisionmakingaboutthe
commissioningofhealthandcareservices,throughjointdevelopmentoftheirhealth
andwellbeingstrategies. Toensurethestrategiesaredelivered,werecommend
thathealthandwellbeingboardsroleshouldbestrengthened.Theyshouldagree
commissioningplans,beabletoreferconcernsaboutcommissioningconsortias
commissioningplanstotheNHSCommissioningBoardandcontributetotheirannual
assessment.
Theremustbetransparencyandopennesswherevertaxpayersmoneyisbeing
spent,andallaccountableindividualsshouldabidebytheNolanprinciplesfor
conductinpubliclife. Commissioningconsortiashouldnotbegiventotalfreedomto
determinetheirowngovernancearrangementswerecommendthattheymustata
minimumhaveagoverningbody,withindependentmembership,whichholds
meetingsinpublicandconsultspubliclyoncommissioningplans.Thesesafeguards
willhelpsecurethebestoutcomesforcommunitiesandhelpguardagainstany
conflictsofinterest.
Finally,atanationallevel,thereneedstobeabsoluteclaritythattheSecretaryof
StateforHealthisultimatelyaccountabletoParliamentforacomprehensivehealth
servicearesponsibilityagainstwhichheshouldannuallyreport.Thisistoo
fundamentalaprincipleonwhichtoallowanyambiguity.
Readthefullreportofthepatientinvolvementandpublicaccountabilitygroupatwww.dh.gov.uk/nhsfutureforum
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ClinicalAdviceandLeadership
ThemostcommonconcernthattheForumheardonthisthemewasthatGPsleading
commissioningdecisionsaspartofcommissioningconsortiawouldnotinvolve
otherswithacontributiontomaketoimprovinghealthandcareservices.Some
groupsfeltthesolutionwastohaveaseatonthegoverningbodiesofcommissioning
consortiatorepresentotherprofessionalgroups.
TheClinicalAdviceandLeadershipreportsaysthattheremustbegenuinemulti
professionalinvolvementandleadershipatalllevelsinthesystem.Wecallfor
strengtheneddutiesoncommissioningconsortiatosecuremultiprofessionalinput
tothecommissioningprocessandfortheauthorisationandannualassessment
processtobeusedtoassurethis.Assessmentoftheskills,capacityandcapabilityof
commissioningconsortiashouldbeplacedattheheartoftheauthorisationand
annualassessmentprocess.Wherecommissioningconsortiacannotdemonstrate
readinesstotakeontheirnewresponsibilitiestheyshouldnotbeallowedtodoso.
Multiprofessionalinvolvementandleadershipshouldbevisiblystrengthenedatall
levelsinthesystem.Thereshouldbeastrongroleforclinicalandprofessional
networksinthenewsystemandmultispecialityclinicalsenatesshouldbe
establishedtoprovideadvicetolocalcommissioningconsortia,healthandwellbeing
boardsandtheNHSCommissioningBoardandtoprovideaforumforcrossspecialty
collaboration,strategicadviceandinnovation.TheClinicalAdviceandLeadership
reportalsocallsformultiprofessionalinvolvementtobeembeddedwithintheNHS
CommissioningBoardandforindependentpublichealthadviceandexpertisetobe
present
at
every
level
of
the
system.
Continuingprofessionaldevelopment(CPD)isessentialtoenableNHSstaffto
continuallyimproveandleadershipdevelopmentisneededsupportthosetakingon
newrolesandresponsibilities.Weheardconcernsaboutthehugevariationinthe
provisionofCPDacrosstheNHSandhowtheprofessionaldevelopmentofallstaff
providingNHSfundedservicesiscriticaltothedeliveryofsafe,highqualitycare.We
recommendthattheNationalQualityBoardshouldexaminehowthesituationcan
beimprovedandtheconstitutionalpledgeto'provideallstaffwithpersonal
developmentandaccesstoappropriatetrainingfortheirjobsbehonoured.Evidencebasedcommissioningisacrucialpartofeffectiveclinicaladviceandleadership.Peoplewantedtoseebetterinformationsystemsandbetterdataabout
outcomes.We,therefore,highlighttheimportanceofinformationsystemsandflows
toenableseamless,integratedpatientcare.Thereportrecommendsthat
commissionersshouldrequireimprovedcollectionanduseofdataaboutoutcomes
ofcaretoenablepatientchoiceandserviceimprovement.Supportforresearchand
innovationisalsoimportantforevidencebasedcommissioningandpracticesothe
reportrecommendsthatcommissioningconsortiashouldhaveadutytopromote
researchandinnovationandtheuseofresearchevidenceintheNHS.
Readthefullreportoftheclinicalandadviceandleadershipgroupatwww.dh.gov.uk/nhsfutureforum
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EducationandTraining
Thisworkstreamwasunusualinthateducationandtrainingwasnotincludedinthe
Bill.
Changes
had
been
proposed
to
the
arrangements
for
education
and
training
commissioningasaconsequenceoftheproposedabolitionofStrategicHealth
Authorities.TheNHSListeningExercisecameontheheelsofathreemonth
consultationontheGovernmentsWhitePaperLiberatingtheNHS:Developingthehealthcareworkforce.Duringthelisteningexercise,andinlinewiththebulkoftheconsultationresponses,
wefoundbroadsupportfortheobjectivesanddesignoftheproposedsystem
alongsideconcerntoensuremaintenanceofhighqualitytrainingresponsiveto
patientsneeds.Patientsneedtohaveconfidencethatservicesandskilled
professionalswillbeavailablewhenandwheretheyareneeded.
Ontheotherhand,whatemergedasoneofthemostwidelyvoicedcriticismsofthe
proposedchangeswasadeeplyfeltconcernattheriskstohealthcareeducationand
traininginEnglandposedbythefastpaceofchange.
EducationandtrainingisthefoundationoftheNHS.Withoutwelltrainedand
motivatedstaffwewillnothavetheelementsnecessaryforaworldclassNHS.
Withoutinvestmentincontinuingprofessionaldevelopmentforallstaff,thecurrent
workforcecannotbeequippedtofacefuturetechnologicalandcaredelivery
developments.Moreover,UKbasedclinicaleducationandtrainingenjoysaworld
classreputationandisavaluablecontributortotheUKeconomy.
Theeffectsofmistakesmadenowintheplanningfortheeducationandtrainingof
healthcareprofessionalswilljeopardisethisandwillhavelongtermeffects. Oneof
ourmainrecommendationsthereforeistotakesufficienttimetoensureanorderly
andsafetransitiontothenewarrangementsforplanningandcommissioning
educationandtraining.
However,twoelementsdoneedtobeaddressedquickly. Werecommendthatthe
proposedHealthEducationEngland,whichhasbeenalmostuniversallywelcomed,
needstobeoperationalassoonaspossibletoprovidefocusandleadershipwhile
therestoftheeducationandtrainingarchitectureisplanned.
Next,whereplansforthenewlocaleducationandtrainingboardscannotbeinplace
bythetimetheSHAsareabolished,theworkforcefunctionsrelatedtoeducational
commissioningandworkforceplanningandthepostgraduatemedicaldeaneries
shouldbetransferredtoahostorganisationuntiltheneworganisationisfunctioning
Wemetconsistentresistancetotransferringtheworkforceplanningfunctionsoutof
theNHSfamilyandsowerecommendfindinganNHShomefortheLocalEducation
andTrainingBoards. Finally,thereneedstobeasubstantialtransitionperiodfor
movingtoalevybasedfundingregime.
Readthefullreportoftheeducationandtraininggroupatwww.dh.gov.uk/nhsfutureforum
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Gettingthepaceofchangeright
ThroughouttheListeningExerciseweheardconcernsaboutthepaceofchange.
Somepeoplefeltthatthechangeswereproceedingtooquickly,withothersconcernedthatthepaceofchangewasnotfastenough.Weneedtostriketheright
balanceandthetransitiontimetableshould,atalltimes,beguidedbythe
philosophythatpatientsmustbetreatedsafely,begiventhehighestqualitycare
possibleandtreatedwithdignityandrespect.Inshort,thepaceofchangeshouldbe
determinedbywhatisinthebestinterestsofqualityandsafetyandthereforethe
bestinterestsofpatients.
TheprincipleofassumedlibertyespousedintheWhitePaperistherightoneand
theGovernmentshouldholdtruetothisvision.Fortheperiodofthetransitionthe
principle
of
earned
autonomy
should
prevail.
Morespecifically,werecommendthat:
theNHSCommissioningBoardshouldbeestablishedassoonaspossibletoensurefocusedleadershipforimprovingqualityandsafetyaswellasmeeting
thefinancialchallengeduringthetransition;
those commissioning consortia that have demonstrated they are ready totakecontrolofbudgetsandthecommissioningprocessshouldbeallowedto
do so fromApril 2013.Where commissioning consortia arenot ready, the
NHS Commissioning Board should commission services on their behalf but
provideallnecessarysupporttoenablethetransferofpowertotakeplaceas
swiftlyaspossible;
allareasshouldhaveshadowhealthandwellbeingboardsassoonaspossibleinorder to support thebuildingof strong local relationshipsand to get to
gripswithunderstanding thehealthandcareneedsof localpopulations to
informemergingjointhealthandwellbeingstrategies;
HealthwatchEngland shouldbeestablishedas soonaspossible inorder toprovidefocussedleadershipforputtingpatientsattheheartoflocalreforms;
changes to the system of education and training must not be rushed.However,HealthEducationEngland shouldbecomeoperationalas soonas
possibletoprovidefocusandleadershipwhiletherestoftheeducationand
training architecture is planned. The roles of the postgraduate medical
Deaneries must be preserved and an interim home within the NHS found
urgently as a consequence of the planned abolition of Strategic Health
Authorities;
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allNHSTrustsshouldcontinuetowork towardsachievingFoundationTrust
statusby2014asauthorisation isaboutclinicaland financial sustainability.
However,2014shouldnotbeanabsolutecutoffdate intheBill.UntilNHS
Foundation Trust governors have been equipped with the right skills and
capability to effectively hold their boards to account, Monitor should
continuetohaveanongoingcompliancerole;
the implementation of Any Qualified Provider should be guided by theprinciples setout in theChoiceMandatewehaveproposedanddrivenby
patients;
Overall,theDepartmentofHealthshouldmoveswiftlytosettingoutanew
transitiontimetabletoprovideclarityforallstaff.