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Proposals to involve frontline nurses in key commissioning talks

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Frontline nurses should be given a say on key commissioning decisions for health services in their area, NHS chiefs have argued. 

They are proposing to make a raft of changes to legislation to enable health and care organisations in England to integrate more easily in order to deliver on ambitions in the NHS Long Term Plan.

“The NHS must be protected from the scourge of unnecessary competition”

Sara Gorton

As well as breaking down barriers between different NHS groups, the amendments will encourage greater collaboration with the voluntary sector and local government.

The authors of the plans note how responsibility for the planning and funding of health services in a local area is currently split between different bodies and this “acts as a hindrance” to integrated care.

They want to see the commissioning of public health, primary care, acute and specialist mental and physical health care to be joined up.

The new plans set out to remove the legal blocks that stop this from happening currently, building on the work already underway through emerging integrated care systems.

They note how, although NHS providers and clinical commissioning groups work together informally at the moment, legislation prevents them from setting up formal joint committees. This should change, said the authors.

They called for “express powers” to be put in place for care organisations and CCGs to form official joint teams and make joint appointments.

“With 41,000 nursing posts currently laying empty, patient care is being compromised”

Donna Kinnair 

In addition, they want to see laws changed so CCGs can appoint a “designated nurse and secondary care doctor” from local providers onto their governing bodies to help make key decisions.

“This would enable joint decisions for the common good, agreeing priorities for improving quality of care, planning how they will achieve their shared aims and making the best use of the collective resources available to them,” the plan stated.

CCGs and NHS providers will be expected work together to achieve: “better health for everyone, better care for all patients, and efficient use of NHS resources” – named the “triple aim”.

The plans were presented at a joint meeting of the boards of NHS Improvement and NHS England yesterday. 

They were written by Ian Dodge, director of strategy and innovation at NHS England, and Ben Dyson, executive director of strategy at NHS Improvement. 

Donna Kinnair

Dame Donna Kinnair

Donna Kinnair

It comes after the Commons’ health select committee concluded in May 2018 that there were strong arguments for changing legislation that acts as a barrier to integration in the best interest of patients.

A month later, the prime minister invited the NHS to come forward with proposals for legislative change.

The plan produced by Mr Dodge and Mr Dyson highlights that current legislative framework that governs the NHS gives “considerable weight to individual institutions working autonomously”.

However, the success of the NHS long-term plan, revealed in January, “depends partly on shared endeavour”.

The proposed changes will give powers to the health and social care secretary to establish new NHS trusts “for the purposes of providing integrated care”.

NHS Improvement will also be given the ability to force a merger between NHS foundation trusts, even if they didn’t want to.

Legislation brought in through the Health and Social Care Act 2012 to drive competition for NHS contracts will be repealed under the plans.

Instead, commissioners will be allowed to give contracts to trusts without necessarily having to open them up to bids from the wider market, in a move hailed as a block against NHS privatisation.

A new “best value test” will be introduced to ensure taxpayers are getting the most for their money.

“Whilst competition can in some circumstances help provide benefits to patients, we are concerned that the comparative weight that current legislation gives to competition will act as a drag on efforts to improve collaboration between NHS bodies and provide integrated care,” the report said.

“They can’t go as far as they would like to because the law hasn’t kept up”

Ian Dalton

Last year, NHS Improvement and NHS England announced that they would form a closer working partnership. This led to the creation of a joint leadership team called the NHS Executive Group, which includes new chief nursing officer Dr Ruth May.

The two organisations are now proposing to take their relationship a step further, which could result in them fully merging.

The report said: “In the spirit of the closer working relationship between NHS England and NHS Improvement, we make proposals to bring our organisations closer together, beyond the current limits of legislation.

“We seek views on how far this closer working should extend, ranging from fully merging our organisations to providing more flexibility in our working arrangements,” it added.

Healthcare staff and members of the public are being urged to share their views on the plans before 25 April this year. The responses will help develop a set of final recommendations to parliament later in the year.

Dame Donna Kinnair, acting chief executive and general secretary of the Royal College of Nursing, welcomed the proposed changes but called for the introduction of safe staffing legislation to be made part of the plans.

sara gorton for index

sara gorton for index

Sara Gorton

“With 41,000 nursing posts currently laying empty across England, patient care is being compromised, but there is currently no law that holds decision makers responsible,” she said. 

Sara Gorton, head of health at the union Unison, welcomed the aspect of the plans that she thought appeared to strive to remove competition and reduce privatisation. 

“As the UK heads into an uncertain post-Brexit world, the NHS must be protected from the scourge of unnecessary competition and predatory private firms taking advantage of a possible weakening of UK trade rules,” said Ms Gorton.

She added that the “market-driven” system ushered in by the Health and Social Care Act 2012 had already “cost the NHS dearly”.

Simon Stevens, chief executive of NHS England, said a message that came through loud and clear during the development of the NHS Long Term had been that progress towards creating a more integrated care system would be “accelerated” with targeted law changes.

Ian Dalton

Ian Dalton

Ian Dalton

NHS Improvement chief executive Ian Dalton added: “Hospitals, local health groups and councils in many areas are already seeing real benefits from greater joint working, but face frustration when they can’t go as far as they would like to improve patient care just because the law hasn’t kept up. 

“So, while it’s possible to implement the NHS Long Term Plan without significant changes, this is a welcome opportunity to hear the views of staff, patients and the public about how we can overcome some of the obstacles to providing the kind of joined-up services we all want to see,” he said.

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