Julia Manning: The Prime Minister’s changes to the Health Bill - at a glance

Julia Manning is Chief Executive of 2020Health.

Past	Present	Comment
Commissioning would be GP led in ‘GP Commissioning Consortia’.	Name change - Commissioning will be undertaken by ‘Clinical Commissioning Consortia’.	We welcome this change in terminology – the commissioning term should have been more inclusive.
GPs could decide who would be on their Commissioning board.	Loss of freedom and primary care focus - They have been told to include a hospital doctor and nurse.	This is a backwards step. A major point of the Bill was to put the planning and buying of services into the hands of frontline, community staff who could relocate services from the local hospital when indicated. This will hamper moving care into the community.
No formal care pathway planning design.	Formalising pathway design - Introduction of clinical ‘Senates’ where clinical staff can come together to plan integrated care.	We welcome this and had called for a formal structure to allow planning of care pathways – this is where hospital staff should be included.
All GPs had to have their consortia ready by 2013 and PCTs would disappear.	No deadline - Local commissioning will only proceed when the GPs are ready. Much more like fund-holding situation.	PCTs have already been downsized and aggregated. Looks like they – and the overarching ‘clusters’ that have been formed, might be with us for some time. This is a very confused picture. However conscripts never did make good volunteers.
Any Willing Provider – more competition welcomed and the regulator Monitor having a duty to promote it.	Competition remains - Any Qualified Provider (name change had already occurred) will remain but not promoted and Monitor will ensure competition is there to ensure quality rises. No ‘volume’ contracts will be given and re-emphasis on only ‘best’ providers being in the field.	There were some positive words about the contribution of the independent sector. They will have to contribute to the costs of NHS training. It will be harder for new entries with no guaranteed income. ‘Best’ providers will have more consequences for NHS than independent sector.
Monitor as an economic regulator	Monitor will also now have a duty to ensure integration.	We think Monitor’s position is becoming confused. We think it should merge with CQC and they should oversee finance and quality together. Integration relies largely on clinical freedom and payment mechanisms.
Reducing Management	Now we have DH + National Commissioning Board + Public Health England + Commissioning Consortia + PCTs + Clusters + SHAs + Senates	Liberating the NHS from bureaucracy has gone out of the window.
Health and Wellbeing Boards	Here to stay	An important part of joining up health and social care.
(18 week waiting time Target & A&E target)	The Bill rhetoric was outcomes not Targets. Outcomes now in addition to not instead of these Targets.	It’s political suicide to get rid of waiting times targets so this is a positive step with the added value of focus on outcomes.
Ring-fenced spending	The spending will increase & by prioritising public health demand will be contained.	With a 50% increase in over 65’s in the next 20 years, nothing is going to stop rising demand. We have to allow more co-payments on top of a universal, basic NHS service.