The Government then asked a leading group of health policy academics (entitled the NHS Future Forum), led by Professor Steve Field, to assess the results of the consultation and make recommendations to Ministers.  This process was completed in June, with Ministers taking up the recommendations of the NHS Future Forum. 

A summary of changes to the Bill is as a follows:

• Ministers will be given overall responsibility for the NHS with a duty to promote a comprehensive health service.
• GP consortia will now be called ‘clinical commissioning groups’ and contain at least one nurse and specialist doctor. 
• Commissioners will be supported by clinical networks (advising on single areas of care) and new ‘clinical senates’ in each area of the country (providing multi-professional advice on local commissioning plans). 
• The dangers of competition in the NHS will be ‘guarded against’ via the following new mechanisms: Monitor’s core duty will be to protect and promote patients (not to promote competition).
• Public accountability and patient involvement will be improved.
• Slowing the timetable for introduction of the reforms to ensure more consultation.

Last week a nurses’ union delivered an overwhelming vote of no confidence in the Secretary of State’s management of the plans.

The government says it is taking advantage of a natural “pause” in the progress of the Health and Social Care Bill through Parliament to hold a listening exercise with health care groups to improve the plans and build more support behind them.

The Prime Minister denied this was a “PR exercise”, adding: “We are looking at proper and substantive changes because we want to get this right.”

He told the SKY programme that he had a personal commitment to the NHS and wanted it to succeed – but it had to be modernised and improved, owing to challenges such as an ageing population.

He said there were some “key elements” to the reforms – making sure hospitals were more independent, keeping foundation trusts, paying by results, giving GPs a “lead role” in commissioning care, and getting politicians to “stand back” from the health service.

There is still little know about how services for rare diseases will be managed differently under the National Commissioning Board that will take responsibility for specialised services.

This publication outlines the Government’s response to public opinion on the NHS reforms and declares how policy will be changed accordingly. Most of the major policy announcements are going ahead, although please find the Department of Health summary of how the proposals will be modified below.

The Department of Health publication states that the Government has decided to:

• Allow a longer and more phased transition period for completing our reforms to providers: for example, retaining some of Monitor’s current controls over some foundation trusts while the new system of economic regulation is introduced.
• Significantly strengthen the role of health and wellbeing boards in local authorities, and enhance joint working arrangements through a new responsibility to develop a “joint health and wellbeing strategy” spanning the NHS, social care, public health and potentially other local services.
• Create a clearer, more phased approach to the introduction of GP commissioning, by setting up a programme of GP consortia pathfinders. This will allow those groups of GP practices that are ready, to start exploring the issues and will enable learning to be spread more rapidly.
• Create a more distinct identity for HealthWatch England, led by a statutory committee within the Care Quality Commission (CQC).
• Increase transparency in commissioning by requiring all GP consortia to have a published constitution.
• Change our proposal that maternity services should be commissioned by the NHS Commissioning Board. This reflects the weight of consultation responses arguing that, in order to focus on local needs, maternity services should be the responsibility of GP consortia, backed by national support to secure improvements in quality and choice.
• Recognise that our original proposal to merge local authorities’ scrutiny functions into the health and wellbeing board was flawed. Instead we will extend councils’ formal scrutiny powers to cover all NHS-funded services, and will give local authorities greater freedom in how these are exercised.
• Phase the timetable for giving local authorities responsibility for commissioning NHS complaints advocacy services, and allow flexibility to commission from other organisations as well as from local Health Watch.
• Give GP consortia a stronger role in supporting the NHS Commissioning Board to drive up quality in primary care.
• Create an explicit duty, for the first time, for all arm’s-length bodies to co-operate in carrying out their functions, backed by a new mechanism for resolving disputes without the Secretary of State having to act as arbiter. In particular, Monitor and the NHS Commissioning Board will have to work jointly in setting prices, rather than have Monitor decide and the Board able to appeal.

The full document is available online at http://bit.ly/e2PNR8.

Health Select Committee Inquiry into commissioning:

The report, published in March 2010,  found a variety of problems in the current commissioning system and the inquiry was launched to ascertain how the new Government plan to resolve the problems. Please find the terms of reference for the inquiry at http://bit.ly/d03grI.

PNH Alliance response:

Summary:

• The commissioning of specialist services will be under the remit of the NHS Commissioning Board, but will require the engagement of GP Consortia to meet the needs of patients throughout their care pathway.
• The National Strategy for Rare Diseases will be fundamental to the successful commissioning of specialist services.
• There should be no regional disparities in treatment and an end to ‘post-code lottery’ prescribing.
• Central leadership will be crucial, specifically the creation of a National Clinical Director for Rare Diseases.
• Treatments for rare diseases should be organised centrally and a budget should be given directly to the planning body for specialist services.
• Best practice commissioning guidelines should be developed and shared, and patients should be notified of their legal position when refused treatment for their condition.
• The commissioning process should be as transparent as possible.
• Consistency of approach is important in that constant reorganisation can cause confusion and inefficiency through poor commissioning arrangements and decisions.

Download the full PNH Alliance response to the Health Select Committee Inquiry into commissioning

Department of Health consultation into commissioning:

The Department of Health launched a consultation into commissioning to analyse further the suggested reform to the commissioning process as outlined in the White Paper Equity and Excellence: Liberating the NHS. This is one of many consultations published by the Government as a way of gauging the opinions of key stakeholders on the proposed reforms. These consultations will then form the basis for the introduction of the Health Bill over the next few months, as the suggested reforms become law. The consultation document is available for download at http://bit.ly/cwA86A.

PNH Alliance response:

Summary:

• The PNH Alliance welcomes the commitment to ensure that national and regional services are commissioned by the NHS Commissioning Board with the support and engagement of GP Consortia.
• The National Plan for Rare Diseases is fundamental to the future of commissioning services nationally and regionally.
• GP Consortia engagement is an essential requirement for these services to be commissioned and managed appropriately.
• There must be clear understanding and co-ordination between all services commissioned by the NHS. An infrastructure that allows for this is essential.
• Specialised services should be available for as many conditions as is appropriate, meaning that fewer patients will continue to experience the inequitable access to care.
• Central leadership will be key to GP Consortia and the NHS Commissioning Board working practically and effectively together.
• The PNH Alliance supports the creation of a National Clinical Director for Rare Diseases, as previously suggested by the Chief Medical Officer.
• Increasing transparency in all decision-making on what will be commissioned nationally, regionally and locally will benefit clinicians and patients across England. The caveat remains that frequent changes to refine this decision-making process must be avoided.

Download the full PNH Alliance response to the Department for Health Consultation into commissioning

05/10 – The Sunday Morning Herald (Aus) – Hope for patients with rare blood disorder

Fewer than 100 Australians with a rare blood disorder are within weeks of winning an 18-month battle to have a drug that will cost taxpayers $35 million a year subsidised by the federal government.

The drug, which is used to treat paroxysmal nocturnal hemoglobinuria, has been recommended by the Pharmaceutical Benefits Advisory Scheme for inclusion on the Life Saving Drugs Program, which funds expensive drugs for about 159 people with extremely rare illnesses.

Only six disorders are funded under the program, launched in 1996, but patients with paroxysmal nocturnal hemoglobinuria must wait for cabinet approval, expected next month.

If approved, the cost of the program will rise from about $76 million a year to $119 million, which includes some funds for other drugs not used to treat ultra-rare conditions, or those that affect fewer than 100 people.

Drugs can be listed only if they have been recommended as clinically necessary and effective, but not recommended for use on the Pharmaceutical Benefits Scheme because of cost-effectiveness.

The full article is available online at http://bit.ly/bANj1v.

Consultation overview and links to find out more:

• The first consultation, published on 19 July and entitled Transparency in outcomes- a framework for the NHS, is an engagement process regarding how the NHS Outcomes framework should be developed. The Coalition government has indicated a cultural shift in the NHS from targets to outcomes and the Outcomes Framework is an important part of this. The consultation can be found online at http://bit.ly/dr6uyc.
• The second consultation, published on 22 July and entitled Liberating the NHS: commissioning for patients, is seeking views on the Coalition’s policy for commissioning including the use of GP consortia and the NHS Commissioning Board. This has been the most debated policy in the media with regard to the reform and is crucial in terms of how services are bought for a local area. The consultation can be found online at http://bit.ly/cwA86A.
• The third consultation - Liberating the NHS: increasing democratic legitimacy in health – was also published on 22 July. This consultation involves the integration of public health improvement into local authorities’ responsibilities and is closely linked to the consultation on commissioning. Under new plans local authorities will shoulder the burden of the public health agenda whilst being given (a yet unspecified) ringfenced budget to do so. The consultation can be found online at http://bit.ly/cxaHYE.
• The fourth consultation published on 26 July, Liberating the NHS: regulating healthcare providers, is the final consultation. This consultation involves restructuring the way in which Foundation Trusts work and reforming the role of Monitor. The new reform will see all hospitals become Foundation Trusts and thus have more independence from central control. Monitor (at present the regulator of Foundation Trusts) will become a broader economic regulator for all healthcare providers. The consultation can be found online at http://bit.ly/9wis0T.

The details of the committee, as can be found on the UK Parliament website, are as follows:

12/07 – House of Commons – Written Answer: NHS: Drugs

Ian Liddell-Grainger (Conservative, Bridgwater and West Somerset): To ask the Secretary of State for Health what plans he has for the future appraisal of drugs for the treatment of ultra orphan diseases.

Simon Burns (Minister of State for Health): In the great majority of cases the National Institute for Health and Clinical Excellence (NICE) will continue to appraise important new drugs. However, for a small number of drugs for very small patient populations, where it is not appropriate for NICE to carry out an appraisal, it may be more appropriate for a drug to be considered by the Advisory Group for National Specialised Services as part of the arrangements for national specialised commissioning.

13/07 – House of Commons – Written Answers

Ian Liddell-Grainger (Conservative, Bridgwater and West Somerset): To ask the Secretary of State for Health what the remit is of the Advisory Group for National Specialised Services.

Simon Burns (Minister of State for Health): The role of the Advisory Group for National Specialised Services will be to advise on:

• which services and technologies should be nationally commissioned;
• which centres should provide them;
• the annual budget for nationally commissioned services and technologies; and
• the high level strategy for nationally commissioned services and technologies.

Liddell-Grainger (Conservative, Bridgwater and West Somerset): To ask the Secretary of State for Health what plans his Department has to implement the provisions of the Council Recommendation for a European Action on rare diseases.

Anne Milton (Parliamentary Under-Secretary for Health): The Department is working with the Devolved Administrations and key interest groups to develop a plan for rare disease by 2013 in line with the Council’s recommendation.

The key policy changes are as follows:

• The commissioning of NHS services will be placed in the hands of GPs through the disbanding of Primary Care Trusts and Strategic Health Authorities. Along with this, all hospitals will be granted Foundation Trust status, meaning that they will receive a greater level of autonomy  from the Department of Health. This is part of the Coalition’s broader drive to devolve power to local communities and empower clinicians. It is also estimated to result in NHS management costs being cut by an estimated 45%.
• Monitor (currently the regulatory body for NHS Foundation Trusts) will receive a strengthened brief – making it the economic regulator for all providers of services.
• An independent NHS board will be created that will oversee GP commissioning and lead on specialised commissioning.
• An ‘any willing provider’ model will be introduced for healthcare, allowing the private sector to bid to provide services as long as standards are met. This is with a view to creating the ‘largest social enterprise sector in the world’.
• An Outcomes Framework (objectives of which to be consulted on this year) will replace the last Parliament’s targets. Again, this is designed to contribute to the cultural shift towards the empowerment of clinicians and the role of Government as reactive not prescriptive in their leadership .
• The PPRS (Pharmaceutical Price Regulation Scheme) will be changed to a system of value based pricing before the present scheme expires (Jan 2014).  The Cancer Fund contained in the Conservative Manifesto will operate from April 2011.
• The payment system in the NHS will be reformed so money follows outcomes not procedures.
• Local Authorities will be able to agree local strategies to bring together health care, social care and public health though allowing them control over local health improvement budgets. They will receive ring fenced public health budgets in order to do this.
• Patient access to information will be increased, and patients will be able to choose their GPs and have more control over the care they receive.  A new body called ‘Health Watch’ will be created to champion patients and ensure they receive access to care.
• A Public Health White Paper will be published later in the year.
• Executive bodies of the Department of Health (quangos) will be cut by ‘at least one third’ with details to be published ‘later in the year’.

The full document is available online at http://bit.ly/bLGa6i.

The full transcript of Andrew Lansley’s speech is available online at http://bit.ly/9NL7HA.

Links to responses to the White Paper:

NHS Alliance: http://bit.ly/abvKFV.

NHS Confederation: http://bit.ly/dxG8ay.

Kings Fund: http://bit.ly/atiNUK.

30/06 – House of Lords – Oral Question: Health: Private Insurance

Lord Crisp (Crossbench) to ask Her Majesty’s Government what controls they propose to put in place to ensure that private health insurance companies adhere to their industry codes of practice.

Lord Sassoon (Conservative, The Commercial Secretary to the Treasury): My Lords, all private health insurers must comply with Financial Services Authority requirements, including those for treating customers fairly, which would include adherence to industry codes. The Financial Ombudsman Service takes account of all Association of British Insurers codes of practice in determining whether a complaint should be upheld and, if so, what the redress should be.

Lord Crisp: My Lords, I thank the Minister for that reply. Does he agree that it is outrageous that an insurer that says it offers full cancer coverage can stop payment for a cancer drug during treatment in complete defiance of that industry code of practice? Will he ensure that the consumer protection and markets authority, which I believe is being created, will properly cover the selling, and perhaps the mis-selling, of private health insurance?

Lord Sassoon: My Lords, I welcome this Question from the noble Lord, Lord Crisp, and I appreciate the concerns that lie behind it. The process by which industry codes, which are not statutory, are enforced has a number of levels. First, the Association of British Insurers makes it a requirement of membership that codes are adhered to by all its members. Secondly, the Financial Services Authority has a process of confirmation of industry codes that are put in place. To be confirmed, those codes have to meet a series of guidelines as to form and content. The FSA takes account of non-compliance in its regulatory decisions. Furthermore, the ombudsman is required by the FOS rules to take industry guidance into account. Therefore, broadly speaking, if a complaint is brought and the code has not been adhered to, there should be a finding in favour of the complainant. I very much regret the situation that the noble Lord described, but it should be picked up if the processes are properly followed.

The full debate is available online at http://bit.ly/dnzby9.