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Stuart Carroll and Gary Jones: If fortune favours the brave, the Government's NHS White Paper makes the right noises and is to be commended

Picture 7 Gary Jones is a member of the Bow Group Health Policy Committee and a public affairs consultant. Stuart Carroll is a senior health economist and chairman of the Bow Group Health Committee. Here they summarise the research paper they have written for the Bow Group on the Government's recent NHS White Paper, which is published today and can be downloaded here.

The Coalition Government’s NHS White Paper represents the most radical Government Health White Paper since the creation of the NHS in 1948. Whilst the White Paper signals relatively few changes in the patient facing end of the health service, the proposals to introduce GP consortia to carry out the bulk of NHS commissioning constitutes a radical and bold step.

These courageous plans have great potential to bring primary care closer to patients with a stronger focus on prevention. However, the smooth and effective implementation of this policy will be necessarily dependent on the removal of a number of practical barriers and strong leadership across the 1.3m people making up the world’s fourth largest organisation.

The Bow Group has today published new analysis on the White Paper, which outlines our considered response to Equity and Excellence: Liberating the NHS – the Health White Paper setting out the Government's long-term vision for the future of the NHS in England.

The analysis focuses on five key areas, which feature prominently in the White Paper. These include 1) GP commissioning, 2) Quality and outcomes, 3) Public health and prevention, 4) Efficiency savings and Quangos, and 5) Value and innovation. Here we summaries the main points from our analysis. 

1. The GP Commissioning Revolution
The most significant and ambitious proposals set out in the White Paper are plans that will see the creation of GP consortia to take on the role of GP commissioning. Consortia will take over commissioning for the majority of NHS services.  It should be recognised that the “commissioning revolution” offers great potential to drive up clinical standards and improve productivity across the NHS.  It is widely considered that PCT commissioning has been a disappointment in recent years and has failed to deliver its potential.  In April 2010, the cross party Health Committee published its report on commissioning concluding that PCTs are not commissioning effectively enough and that they often lack the “clinical knowledge” to challenge hospitals over the provision of services.

It is clear that enhanced GP commissioning represents an opportunity for positive change.  However, this radical reform confers a number of practical barriers, which the Government will need to be overcome.  This is not least the case when demonstrating to the public, and the healthcare system as a whole, that the devolution of around £80 billon of NHS resource is a wise move with previous funds being spent efficiently and effectively. In addition, it is not clear how GPs will share the risks and rewards of their enhanced roles. 

It is likely that many GPs will anticipate benefiting financially from the new model as they acquire new responsibilities. It will be essential that the Government sets out a clear framework to ensure that there are robust rules on transparency and accountability so that everyone involved – GPs, PCTs, hospitals, contracted companies – know exactly where they stand, and most importantly, remain directly accountable to patients.

2. Quality and Outcomes
A substantial part of the White Paper is dedicated to outlining how the improvement of healthcare outcomes for all will be the primary purpose of the NHS. A new NHS Outcomes Framework will be the main mechanism for driving up quality and promoting equity and excellence across all services, and will provide an indication of the overall performance of the system within an international context. Whilst it is encouraging that the framework is focused on outcomes, it will be crucial that this framework is not too prescriptive and still allows local consortia to innovate. 

3. Public Health and Prevention
The White Paper makes direct reference to the Government’s big idea to place public health and prevention at the centre of the new NHS.  To this extent, the Government has pledged to create a new Public Health Service with a White Paper on public health promised later this year.  These are promising proposals, which will need to be fully backed and funded should the NHS revolution be fully and properly implemented – something that is much needed to safeguard the future health of the nation and financial sustainability of the NHS itself.

4. Efficiency savings and Quangos
It is difficult, if not impossible, to contend the assertion that the NHS could not be leaner, meaner and generally more efficient.  After all, there is no escaping the appalling legacy of waste and profligacy of the previous Labour Government in which, regrettably, the NHS was a serial offender. It is from this perspective that Andrew Lansley is right to emphasise and prioritise the need to make savings where possible and reform the culture of the NHS to allow for a more effective and efficient healthcare system.  We therefore welcome the White Paper’s emphasis on reforming the culture of the NHS, but question the feasibility of cutting “management costs” by more than 45% in 4 years as part of the pledged £20 billion efficiency drive.

5. Innovation and value
Our analysis backs Andrew Lansley’s call for the NHS to find new and innovative ways to put itself on a more economically sustainable footing, but warns that the Government must apply a true definition of innovation and value placing greater stress on the quality of spending and the overall return on investment accruing from investment decisions. In addition it is not clear what the new Government’s definition of innovation and value in the new NHS really means and what is lacking is a real definition as seen as part of daily procurement and tender decisions moving forward. 

If fortune favours the brave, then the new White Paper makes the right noises and certainly scores high marks out of ten. The Coalition’s plans offer the opportunity to deliver the ambition of bringing primary care closer to patients with a stronger focus on prevention. However, the smooth and effective implementation of policy will require more detailed proposals than those currently set out in the White Paper, and the strong and steadfast leadership across the healthcare system.  With this in mind, the key for the Coalition Government will be to flesh out key proposals over the coming months to overcome the likely obstacles and deliver a health system which is genuinely patient-centric achieving outcomes that are amongst the best in the world.


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