Ruislip Residents' Association

This was the first meeting of the National Commissioning Board after assumption of its full responsibilities and change of name to NHS England on 1^st April 2013.  This meeting was held in its London Region office in Maple Street, a turning off Tottenham Court Road..

The meeting was broadcast live on the NHS England website, which in a few days’ time will offer the option to view each agenda item as a separate video.

Although held in public, there were only three sets of papers available and there was no opportunity for even questions of clarification.  The Community Voice, of which Ruislip Residents is a member, has written to the Chairman about these issues, also about better publicity for future meetings, and asking for meetings in public on local London issues.

Key points from the previous minutes included:

To report accidents and emergencies from mobile 'phones, dial 112.  This number connects to local emergency services in 70 countries worldwide, so it is useful for holidays abroad as well as in UK.

In places where poor signals or high volumes of traffic make voice connections difficult, it may still be possible to send text messages  - but that is possible only if the mobile 'phone has been registered in advance.  Full details about the 112 service, including how to register a mobile'phone, are available on the short video accessed by clicking this link:     http://www.youtube.com/watch?v=XPZv_8dABfU

The mandate has five key areas, which impact on local NHS hospitals and community services.

• Preventing people from dying prematurely
• Enhancing quality of life for people with long-term conditions
• Helping people recover from episodes of ill health or injury
• Treating and caring for people in a safe environment and protecting them from avoidable harm
• Ensuring that people have a positive experience of care

Patients expect all the listed items as a basic part of good health services.  However, scandals and shortcomings about patient care hit the headlines from time to time, so the basic assumptions need to be reinforced. 

From next April, all hospital in-patients and those attending A&E will be asked whether they would recommend the hospital to their own family and friends.  Hoping for good survey results, local hospitals are urging staff to focus on the key areas in the NHS mandate, giving patients a good experience as well as good treatment.  See the November report on our Hillingdon Hospital page for what is happening there.

Peter Appleton was the main guest-speaker at the September 2012 meeting of the Community Voice, of which we are a member.  He is Clinical Leads Business manager within the Programmes and Operations Directorate of NHS Connecting for Health and he outlined the main features of the NHS programme called "Choose and Book".

1. He gave a detailed run through of the development over the last 8 years, and said that approximately two thirds of all outpatients in England are now referred and booked using the system.
2. 50% of all consultant led appointments are carried out through Choose and Book, plus another 15% to 20% on top of that for GPs with Special Interests, Allied Health Care Professionals and triage services.
3. All clinics and all priorities can be sent through the system, and all clinics and appointments are controlled by the local NHS – not the national team.
4. He explained that all patients have a legal right to choose where they go for treatment, and that this discussion should normally take place in the GP consulting room.
5. There are sometimes locally agreed rules in place between a GP and the local commissioners (PCT) where local patients may not be offered a choice, but he said that these can be tactfully challenged.
6. A patient should be able to choose any clinically appropriate hospital anywhere in England, although many want one of their local hospitals, with date and time being an important factor.
7. A patient’s choice can include many private hospitals that now offer NHS care to patients; there is no cost to the patient and the hospital only receives the same amount of money as a NHS hospital.
8. The patients choice may be determined by the GPs recommendation, or by hospital reputation, or length of waiting times or other factors that are important to a patient.
9. All the key information is on the Choose and Book screen in front of the GP to help him or her agree with the patient the best choice, or choices that are appropriate.

Jeremy Hunt is named as replacement for  Andrew Lansley as Secretary of State for Health in  today's Cabinet reshuffle!

Summary of key actions (extracted verbatim from the White Paper)

The Government will work with partners – including carers, people who use services, local authorities, care providers and the voluntary sector – to make our vision a reality.

The key actions we will take include:

• Stimulating the development of initiatives that help people share their time, talents and skills with others in their community.

• Developing and implementing, in a number of trailblazer areas, new ways of investing insupporting people to stay active and independent, such as Social Impact Bonds.

• Establishing a new capital fund, worth £200 million over five years, to support the development of specialised housing for older and disabled people.

• Establishing a new national information website, to provide a clear and reliable source ofinformation on care and support, and investing £32.5 million in better local online services.

• Introducing a national minimum eligibility threshold to ensure greater national consistency in access to care and support, and ensuring that no-one’s care is interrupted if they move.

• Extending the right to an assessment to more carers, and introducing a clear entitlement to support to help them maintain their own health and wellbeing.

• Working with a range of organisations to develop comparison websites that make it easy for people to give feedback and compare the quality of care providers.

• Ruling out crude ‘contracting by the minute’, which can undermine dignity and choice for those who use care and support.

• Consulting on further steps to ensure service continuity for people using care and support, should a provider go out of business.

• Placing dignity and respect at the heart of a new code of conduct and minimum training standards for care workers.

• Training more care workers to deliver high-quality care, including an ambition to double the number of care apprenticeships to 100,000 by 2017.

• Appointing a Chief Social Worker by the end of 2012.

• Legislating to give people an entitlement to a personal budget.

• Improving access to independent advice to help people eligible for financial support from their local authority to develop their care and support plan.

• Developing, in a small number of areas, the use of direct payments for people who have chosen to live in residential care, to test the costs and benefits.

• Investing a further £100 million in 2013/14 and £200 million in 2014/15 in joint funding between the NHS and social care to support better integrated care and support

This highly contentious Bill has at last completed its parliamentary passage.  It is expected to receive Royal Assent within a few days and it will then become law.  Its impact will be very great.  We must hope that the worst forebodings about it are too pessimistic and that everyone will endeavour to make the new systems work to the benefit of NHS patients.

Ruislip Residents' Association is a member of The Community Voice, which had the pleasure of welcoming Patrick South from The King's Fund as guest speaker at its meeting on 2nd February 2012.  His interesting address is summarised below:  
    The Speaker’s last visit was in November 2010.  He proposed to review developments since that time, noting that the King’s Fund is a non-aligned think-tank, which talks widely, including MPs and Ministers.

    The earlier White Paper aimed to improve services at lower cost by giving more powers to clinicians, placing patients first, and replacing targets with outcomes – with no more top-down reorganisations.

    The big idea was GP commissioning.  Initially GPs were enthusiastic but concerns grew about choice and competition, and about the amount of reorganisation proposed. There were early signs of trouble in November 2010 when the Chair of the Royal College of GPs claimed that the Bill could destroy the NHS.

    The Health and Social Care Bill was published in January 2011, a very long document in two volumes, which faced discontent at the Lib.Dem. Conference in March 2011, with a motion passed against the Bill.

    By July 2011, mounting criticism led the government to halt the Bill, although it had passed through the Committee stage in the Commons.  Steve Field, ex-Chairman of the Royal College of GPs was appointed Chairman of the NHS Future Forum, which undertook a listening exercise on the Bill.  Proposals for changes followed before the Bill’s return to the Commons.  Its subsequent passage through the Lords was stormy, with various amendments made.  It is now about to embark on the Lords Report Stage and is likely to be passed.

    From July 2011 the BMA campaigned against the Bill. Views are now very polarised.  Some Royal Colleges are calling for the Bill to be scrapped. The King’s Fund has concerns but supports some of the changes in the Bill.

    Implementing clinical commissioning was always going to be a big challenge. Not all GPs are ready to take that responsibility.  The King’s Fund supports clinical rather than GP commissioning and new health and wellbeing boards  which will see health and social care working together, and welcomes both greater public involvement and clinical networks, although the networks’ function is unclear. CCGs will now be established in full or in shadow form by April 2013.

    From the start, the Bill’s most controversial aspect concerned competition and choice.  Initially Monitor had a duty to promote competition - this has been amended so that Monitor’s prime responsibility is now to promote the interest of patients.  Competition was also initially allowed on price as well as quality - this was dropped after strong opposition by the BMA and the King’s Fund among others. Other controversial features included commissioning from “any willing provider”, now modified to “any qualified provider”, and the requirement for all NHS hospitals to become foundation trusts, on which the 2014 deadline has been relaxed.  There is now a stronger emphasis on promoting integrated care for people with long-term conditions.

    There are major structural changes in the Bill with Strategic Health Authorities and Primary Care Trusts proposed for abolition in April 2013, and temporary arrangements in the mean-time.  Local authorities will be more involved through the creation of health and wellbeing boards and will be responsible for public health.  A National Commissioning Board is proposed, with around 50 regional branches. The proposals involve losing around 10,000 NHS Managers, which the King’s Fund considers reckless. It fears loss of institutional memory and lack of strategic responsibility for reorganisation of hospitals.  Overall, despite this and concerns over its complexity, it considers the Bill greatly improved.

    However, by 2015 the NHS requires efficiency savings greater than any system in the world has ever achieved, risking major service cuts if these savings cannot be achieved. The King’s Fund believes it would have been better to focus on those issues instead of NHS reorganisation. It is also concerned about potential NHS staff unrest and fears that quality of care may suffer. The expected Social Care White Paper will have to address the issue of future funding for social care.

    In terms of current performance, the NHS is still doing a good job, with waiting lists and other key indicators stable, but in some localities hospitals are struggling.  An enormous challenge remains.

The speaker answered many questions before being thanked by the Chairman and receiving warm applause.