NHS Long-term Plan: legislative proposals

NHS Long-term Plan: legislative proposals
Health and Social Care Select Committee 24 June 2019

• The Committee found that NHS England and NHS Improvement proposals  for legislative changes to the Health and Social Care Act 2012 in many cases continue the direction of travel towards a more integrated collaborative and placed-based system. It broadly supports NHS England and NHS Improvement’s proposals to:
• to promote collaboration and lessen the role of competition in the NHS, especially the proposal to repeal section 75 of the Health and Social Care Act 2012 and revoke the regulations made under it;
• remove the Competition and Market’s Authority’s role in mergers of foundation trusts;
• ease the burden procurement rules have placed on the NHS, ensuring commissioners have discretion over when to conduct a procurement process, with the inclusion of a ‘best value’ test; and
• allow greater flexibility locally over payment systems.
• However the Committee comments that the plans remains too NHS-centric rather than looking at the wider system with which it seeks to integrate and that the Department of Health and Social Care, NHS England and NHS Improvement should be clearer about the roles local government, the voluntary and community sector and independent providers should play in the future of the NHS.
• Themes of the report are competition, integrated care, NHS leadership, and Cross-party endorsement of legislative proposals

Devolving healthcare services redesign to local clinical leaders: does it work in practice?

Devolving healthcare services redesign to local clinical leaders: does it work in practice?
J Health Organ Manag. 2019 Mar 28;33(2):188-203.

• Investigation into the impact of policy changes resulting from the 2012 Health and Social Care Act on instances of service redesign by local leadership.

Abstract

Understanding the new commissioning system in England

Understanding the new commissioning system in England: contexts, mechanisms and outcomes
PRUComm 30 November 2018

• This study explores how the new commissioning system is functioning after reorganisation of the NHS in England in 2012. The research aimed to assess the impact of the reforms on the operation and outcomes of the commissioning system.

See the other report by PRUComm : Investigating recent developments in the commissioning system

Investigating recent developments in the commissioning system

Investigating recent developments in the commissioning system
PRUComm November 2018

• A description of the complex changing landscape in which CCGs are working.

See also the other PRUComm report : Understanding the new commissioning system in England

Amending the 2012 Act: can it be done?

Amending the 2012 Act: can it be done?
Kings Fund 25 October 2018

• This short piece identifies some of the main complaints about how the Health and Social Care Act 2012 operates; outlines some of the implications should attempts be made to amend it; and asks how far progress could be made within the existing legislation.
• Speaking to the Public Accounts Committee 2018 Simon Stevens has said that the question will inevitably arise as to whether there are aspects of the current legislation that, if amended, ‘would accelerate our progress’. He indicated that, once the long term plan is published, "the current intention is to produce ‘between November and Easter’ and ‘with colleagues across the NHS’ options for legislative change."

What is commissioning and how is it changing?

What is commissioning and how is it changing?
Kings Fund  18 September 2017

• A blog by looking at the commissioning process, the organisations involved and how it is changing.

What has changed in public health commissioning since the HSC Act 2012?

Commissioning for health improvement following the 2012 health and social care reforms in England: what has changed?
PRUComm 27 February 2017

• This paper explores the ways in which the reforms of the Health and Social Care Act 2012 have altered public health commissioning.
• This research using surveys, interviews and case studies suggests that, while some of the intended opportunities to improve population health and create a more joined-up system with clearer leadership have been achieved, fragmentation, dispersed decision-making and uncertainties regarding funding remain significant challenges. There have been profound changes in commissioning processes, with consequences for what health improvement services are ultimately commissioned.

Public health post-2013 - structures, organisation, funding and delivery inquiry

Public health post-2013 - structures, organisation, funding and delivery inquiry
Health Committee 1 September 2016

• Analysis of the impact of the Health and Social Care Act reforms on the public health landscape. 
• The report examines public health funding and how the new PH structures and organisations are working and warns of risks of widening health inequalities and a false economy due to cuts in local authority and public health budgets.

How is the new NHS structured?

How is the new NHS structured?
Kings Fund 11 April 2016

• A series of organograms explaining how the NHS in England is now structured, including how providers are regulated, who can influence the commissioning of services and how the money flows.
• The new NHS: how providers are regulated and commissioned
• The new NHS: who can influence commissioning of services?
• The new NHS: how the money flows
• How the money flows – medical and professional education and training

The NHS following the Health & Social Care Act 2012

The structure of the NHS in England
Commons Briefing papers CBP-7206, June 2015

• This Library briefing provides an overview of the funding and accountability relationships under the Health & Social Care Act 2012, and an introduction to the roles of key organisations and their duties: including NHS England and CCGs; Monitor and the Care Quality Commission; Public Health England and local authorities; Health and Wellbeing Boards; NICE
• It also highlights some of the key health policy issues for the current Parliament, including patient safety, funding, and the integration of health and social care.

Examination of the new public health infrastructure

PHOENIX: Public Health and Obesity in England – the New Infrastructure Examined
PRU Comm, April 2015

• The PHOENIX project aims to examine the impact of structural changes to the health and care system in England on the functioning of the public health system resulting from the Health and Social Care Act 2012. 
• The research is based on surveys of Directors of Public Health and Councillors,  and detailed study of the commissioning system around tackling obesity in five councils/authorities.
• It examines the organisation and position of public health in the councils and related organisations (including CCGs), resources, and relationships and functions within the local public health system,.
• The findings highlight the fragmentation of the new system, and the continued state of change as structures and processes emerge, and as roles and relationships are developed. It also highlights that councils work differently with more accountability and a need to work with others.
• "At the local level, there appears to be stronger managerial accountability and scrutiny, led by elected members (influenced by their politics, ideology and granular knowledge). This is shining a new light on public health activity, and is bringing an important window of opportunity for change – we saw evidence of historical commissioning decisions being challenged, new questions being posed, new suggestions being made, and ‘permissions’ being granted to think differently." p37 

Analysis of NHS Reforms under the coalition government

The NHS under the coalition government: Part one: NHS reform
Kings Fund 6 February 2015

• This report covers six major themes of the coalition government’s reform programme and describes the situation the coalition government inherited when it came to power in 2010, the policies it has pursued, and (where available) evidence of their impact.
• Themes:
• commissioning of care
• provision of care
• regulation of care
• competition
• governance and accountability
• integration of care.

A councillor's guide to the health system in England

A councillor's guide to the health system in England
LGA, 15 May 2014

• This briefing includes:
• a short introduction to the health and social care system since the reforms of 2012
• a description of the different parts of the health system, national, regional and local their interrelationships with each other and with social care and the wider role of local government
• a discussion of the role and potential contribution of elected Members to health 
• ‘must knows’ for councillors with different roles and where they can get further information. 

Public health responsibilities and spending

Local authorities’ public health responsibilities (England)
(House of) Commons Library Standard Note, 14 March 2014

• This note sets out the main statutory duties for public health that were conferred on local authorities by the Health and Social Care Act 2012. 
• The note includes information on public health funding; how local authorities have been spending their ring-fenced public health grants; and on accountability arrangements. 

The new NHS in the words of the leaders

A Guided Tour of the New NHS
All Party Parliamentary Health Group, [2014]

• One page essays by leaders of the new NHS structures including NHS England, Monitor, CQC, HEE, TDA. 

NAO analysis of health reform transition

Managing the transition to the reformed health system
National Audit Office, July 2013

• This report examines how the Department of Health and the NHS implemented the transition from the existing to the reformed health system. It builds the NAO National Health Service Landscape Review (2011) which outlined the key changes that the government proposed to make. 
• "The Department of Health and the NHS faced major challenges in implementing the reforms by 1 April 2013. The reforms are regarded as the most wide-ranging and complex since the NHS was created. More than 170 organisations have been closed and more than 240 new bodies created.
• The reforms are reported to have cost £1.1 billion to 31 March 2013, 15 per cent more than expected at this point. The Department is confident that total costs will not exceed £1.7 billion. The estimated costs are outweighed by the estimated savings in administration costs arising from the reforms."
• Read the analysis in Public Finance here.

The new organisations...

Guide to new health and care system 
Department of Health

• A brief introduction to the statutory bodies making up the new health and care system, explaining how they will work together in the interests of patients and communities.

Health and Social Care Act - a guide for local government

Get in on the Act: The Health and Social Care Act 2012
Local Government Association, 28 June 2012 ( 48pp)

• A summary of all the provisions of the Act and more details about the provisions of particular relevance to local government.