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NHS: Health Reform

Volume 684: debated on Thursday 13 July 2006

Today we are publishing two publications which will take forward our commitment to place patients and the public at the heart of the way our health services are run: Health reform in England update and commissioning framework; and A Stronger Local Voice, which sets out the Government's plans for the future arrangements to support public involvement in health and social care.

The update on health reform sets out a clear vision: to develop a patient-led NHS that uses available resources as effectively and fairly as possible to promote health, reduce health inequalities and deliver the best and safest possible healthcare.

The centrepiece of today's update publication is a framework for commissioning. It will act as a manual for new primary care trusts to achieve excellence in the way they secure healthcare for their local people.

Commissioning is the means by which we secure the best possible healthcare and outcomes, including reduced health inequalities, within the money made available by the taxpayer. Commissioning itself is not new, but stronger primary care trusts and the acceleration of practice-based commissioning—together with the powerful new set of incentives and mechanisms introduced by the health reforms—provide the opportunity for far more effective commissioning that will benefit patients and taxpayers alike.

Effective commissioning will require:

real community engagement and a stronger voice for patients achieved through increased choice, widespread involvement and greater opportunity to influence changes to services;

clinical engagement through practice-based commissioning;

improved information to support commissioning; and

commissioning levers through choice, payment by results and robust contracts.

The reorganisation of PCTs, the moves towards universal coverage of practice-based commissioning, and the establishment of the specialist commissioning groups will provide the basic architecture for commissioning NHS services.

The Department of Health will be seeking views from the NHS and partner organisations over the summer on the key proposals to inform final decisions. Views are sought on options for contracting in the NHS, a governance and accountability framework for practice-based commissioning and triggers for petitions.

The framework sets out the development programmes we are making available to all PCTs as they build on the good commissioning practice that already exists. We are also issuing an OJEU notice today to procure a framework agreement and call-off contract which will enable PCTs to draw on private sector expertise to support their commissioning. This does not in any way affect or relate to PCT directly provided services. PCT boards will be entirely free to choose to what extent, if any, they make use of the call-off contract. In all cases the PCT board remains accountable and responsible for all commissioning decisions.

This commissioning framework focuses on commissioning NHS services, and in particular commissioning hospital services. This is the first step in making commissioning truly effective. We know that joint commissioning of services with local authorities and commissioning for health and well-being are important too. A second framework covering these wider issues will be published in December.

The commissioning framework is supported by an update on the other elements of the reform programme: choice, provider reform, workforce, system management, tariffs and other financial incentives and information.

Effective commissioning will require real community engagement. The commissioning framework will therefore work alongside A Stronger Local Voice, which sets out the Government's plans for the future arrangements to support public involvement in health and social care.

These include plans to build on patient and public involvement forums through the creation of local involvement networks (LINks). The networks will provide a flexible vehicle for communities and groups to engage with health and social care organisations, and will promote public accountability in health and social care through open and transparent communication with commissioners and providers.

We also plan to simplify and strengthen the legislative requirements currently set out in Section 11 of the Health and Social Care Act 2001, to clarify the duties on all NHS bodies to involve and consult patients and the public on all services they provide or commission. There will be a new duty placed on commissioners to respond to what patients and the public have said.

We believe that the new environment being created by the reforms, using incentives and commissioning, will mean that commissioners become advocates for patients and taxpayers, driving up the quality, fairness, responsiveness and value for money of NHS services.

Copies of all today's publications have been placed in the Library.