Our ref: rw\fromzogA\220311
22 March 2011
Dear Dr Alienfromzog
I have now received a response from Earl Howe, Parliamentary Under Secretary of State for Quality, regarding the Health and Social Care Bill.
As you will see from the attached copy, Earl Howe explains how he believes the proposals in the Bill build upon the best parts of the current system, putting patients at the heart of the NHS, focussing on high quality care, empowering local organisations and professionals and making services more directly accountable to patients.
In his letter, Earl Howe emphasises that the Government does not intend to privatise the NHS. Rather, by introducing a degree of competition, it aims to drive up the quality, responsiveness and efficiency of the services on offer. Earl Howe assures me that modernisation plans will not compromise patient safety and anticipates that around 60 per cent of Primary Care Trust (PCT) and Strategic Health Authority (SHA) staff will transfer to other organisations, such as GP Consortia and the NHS Commissioning Board. He explains that this reduction in administrative spending will also mean that there will be more money available to be spent on frontline services.
I hope that this information is helpful. Please do not hesitate to contact me if I can be of any further assistance on this, or indeed any other matter. If you would like to discuss this issue in more detail, I would be very pleased to meet with you at one of my upcoming surgeries, which are advertised on the website: [link provided].
Lib De Mocrat MP
Liberal Democrat MP for the [________] Constituency
Thank you for your letter of 10 February to Andrew Lansley enclosing an example of correspondence you have received from a number of your constituents about our proposals for the modernisation of the NHS. I am replying as the minister responsible for this policy area.
As your constituents are aware, our vision is of a modern NHS built around patients, led by health professionals, and focused on delivering world-class healthcare outcomes. In some areas, England’s health outcomes lag behind those of the best international healthcare systems and. despite huge spending increases in the last decade, productivity has fallen .An ageing population and advances in expensive medicines and treatments mean that the NHS cannot afford to stand still. Our proposals are therefore based on three mutual re-enforcing themes:
• putting patients and the public at the heart of the NHS through much greater choice for patients.
• focusing the NHS on what matters most to patients - high quality care, not narrow process targets; and
• empowering local organisations and professionals by reducing political
interference and making services more directly accountable to patients and communities.
Above all, we will uphold the founding principle of the NHS as a comprehensive service based on clinical need not people’s ability to pay.
Your constituents raise concerns that our plans will privatise the NHS. I would assure them that our proposals are not about privatising the NHS, we simply Want patients to be able to choose to be treated wherever they want – whether an NHS hospital, or one in the voluntary or private sector. The NHS has always worked with the voluntary sector, including social enterprises and charities to meet the needs of its patients.
Our plans to modernise the NHS still allow for more integration of services and more competition. Commissioners will have greater scope to develop integrated care pathways where this makes sense. And new health and wellbeing boards will promote integration across the NHS, social care and public health.
On the subject of competition, I would like to be clear that the government is not promoting price competition. Competition will continue to be on the basis of quality. Variations on the tariff price would be allowed only where quality is maintained or improved. Any such changes to prices would be agreed between commissioners and providers.
We are very clear that competition is a means for driving up quality, responsiveness and efficiency rather than an end in itself. It must operate in patients’ and taxpayers’ interests. The Department’s aim is to free up the provision of healthcare, so that, in most sectors of care. Any willing provider can provide services so long as they meet NHS standards and prices. This will give patients greater choice over their care and ensure effective competition stimulates innovation and improvements and increases productivity within a social market.
A large part of NHS hospital services have been open to competition for some time now. Whether or not European Union (EU) competition law will apply depends on a number of variables, such as the extent of competition for certain services. Our proposals are based on delivering better quality and outcomes for patients. There is no requirement in EU competition or procurement law that would force NHS commissioners to accept bids at the lowest price.
Your constituents also express concerns about abolishing the private patient income cap for foundation trusts (FTs). Removing the cap will free providers to generate extra income to improve existing services and develop new ones, resulting in better care for NHS patients. The principal purpose of FTs will remain to provide NHS patients with timely, high-quality care. Our proposal to repeal the cap helps, rather than hinders, that principal purpose: any surpluses can only be reinvested within the FT, allowing it to improve the level and quality of service available to NHS patients.
I note your constituents’ concern that now is not the right time to embark upon change when there is a pressure to make savings. However this is exactly the reason change is required to make the NHS efficient and sustainable. Our plans will enable the NHS to function much more efficiently by reducing bureaucracy and incentivizing quality and efficiency.
I can assure your constituents that patient safety and the quality of services are paramount and our modernisation plans will not compromise safety. Providers must register with the quality regulator, the Care Quality Commission, whose role is to ensure essential levels of safety and quality of care.
With regard to emergency preparedness, a new, dedicated, professional public health service, Public Health England will he set up as part of the Department of Health to strengthen the national response on emergency preparedness and health protection. The arrangements are detailed in the White Paper Healthy Lives, Healthy People, Our strategy for public health in England on the Department’s website www.doh.gov.uk by typing the reference number ‘15149’ into the search bar.
It is inevitable that there will be some job losses in the NHS. The reason primary care trusts (PCT) and strategic health authorities (SHA) are being abolished is because they are part of the top-down command and control system that gets in the way of clinicians doing their job. We need to dismantle the structures that sustain that approach and cut administration costs. With commissioning being carried out in the future by GP consortia, there is no reason to keep PCTs.
We recognize that there are talented people working in PCTs and SHAs. There will be plenty of jobs for skilled managers in the future. It is anticipated that around 60 percent of the staff from PCTs and SHAs will transfer to other organisations including consortia and the NHS Commissioning Board. Consortia and PCTs will work together to manage the movement of appropriately skilled staff into the new organisations to avoid unnecessary redundancy costs in line with best human resources practice and equal opportunity law. Furthermore, the reduction in administration spending will mean that money can be spent on frontline services.
Where shall transfer to GP consortia under the Transfer of Undertakings (Protection of Employment) Regulations and/or the Cabinet Office’s Statement of practice on staff transfers in the public sector, their terms and conditions of service will be protected on transfer.
In all other cases, the Government is com mitted to preserving individual employer’s ability to decide locally whether to use national terms and conditions or to create local systems. FTs already have the freedom to set pay and terms and conditions, and GP consortia will also have this freedom. It will be for individual employers to decide, with their employees, what are the best solutions for them.
Finally, I would like to reassure your constituents that we consulted widely on the White Paper, Equity and Excellence, Liberating the NHS, and received over 6,000 responses. As a result, we have set out with clarity why and how we need to modernize the NHS and ensure its sustainability for the future. The vast majority of respondents to the consultation agreed with the principles of our modernisations. Of course, some people opposed our plans and there were many specific concerns and suggestions for improvements put forward. We adapted our legislative and implementation plans in the light of consultation responses and set out how we had modified our proposals in Liberating the NHS: legislative framework and next steps. Enthusiasm for reforms is demonstrated by the number of GPs that have come forward to form GP pathfinder groups, which now cover 50 per cent of the country
I hope this reply clarifies the Department’s position on the matter.