The government last week published proposals to amend the Health and Social Care Bill, following a “listening exercise” on its NHS reforms. Below are the key changes that will impact on nurses. Further details of changes to the legislation are due to be published this week.
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GP consortia have been rebranded as “clinical commissioning groups” to reflect the wider involvement of health professionals other than GPs in NHS decision making.
Commissioning groups must have a registered nurse, a hospital doctor and two lay members on their board. These boards will have to meet in public, publishing their minutes and details of contracts.
The geographical boundaries of these groups should “not normally” cross those of local authorities. Their names must include the initials “NHS” and have a “clear link to their locality”.
Duty of candour
There will be a new contractual requirement on NHS trusts and other providers to be “open and transparent” in admitting mistakes.
Strategic health authorities
SHAs will be clustered in the same manner as primary care trusts have been grouped together. This process is expected to take place later this year. There are expected to be four SHA clusters. SHAs are set to disappear in April 2013.
Clinical senates and networks
Clinical networks will be expanded in number to take in more disease areas. Doctors and nurses will be invited to form “clinical senates” in local areas to advise commissioning groups and scrutinise their plans.
NHS Commissioning Board
The board will establish “close links” with the royal colleges and other professional bodies to “firmly entrench” expert partnership working. It will have both a nursing director and medical director.
The board will also have “local arms”, which will reflect current PCT clusters.
Clinical commissioning groups will have a new duty to promote research, as will the health secretary and the NHS Commissioning Board.
Health and wellbeing boards
These boards, made up of councillors and representatives of social care, will have more influence over commissioning groups than previously planned. They will have a “clear right” to send plans back to groups or the NHS Commissioning Board if they are not in line with other local strategies.
The boards will be able to “insist upon” elected councillors making up the majority of their members, potentially handing a greater say over healthcare commissioning decisions to local authorities than before.
The new body Public Health England will be an “executive agency” of the Department of Health, ensuring the advice it provides is independent.
Patient choice, competition and privatisation
The core duty of the regulator Monitor will be to protect and promote patients’ interests rather than to “promote” competition within the NHS - representing a significant change from the current bill.
Instead the NHS Commissioning Board will be issued with a “choice mandate”, setting out clear expectations to promote choice.
The mandate will make it a priority to extend the use of personal health budgets.
The government will “narrow” Monitor’s powers over anti-competitive purchasing behaviour, so the focus is more on preventing abuses rather than promoting competition. Existing rules on competition will be retained and policed by the Cooperation and Competition Panel, which will become part of Monitor.
The new patient watchdog HealthWatch England will have the power to establish a “citizens’ panel” to look at how choice and competition are being implemented.
Education and training
Details on the transfer to the new system for education and training, which will see responsibility for funding move from SHAs to trusts and other providers, will be published in the autumn.
The health secretary will be given an “explicit duty” to maintain a system for education and training.
Foundation trust status
The April 2014 deadline for all trusts to achieve foundation status has been dropped. However, the 116 trusts that are non-FTs will be expected to become foundations “as soon as clinically feasible”.
Secretary of state
After planning to remove it, the health secretary will continue to have a duty to provide a comprehensive NHS.
Clinical commissioning groups and the new NHS Commissioning Board will have a duty to “take active steps to promote” the NHS Constitution.
Your guide to the NHS reforms