The Coalition Government published its White Paper on health reform, Equity and excellence: liberating the NHS, on Monday 12th June.
The plan states that all NHS trusts will either become, or become part of a foundation trust. In his statement to Parliament, the Secretary of State used the White Paper to reiterate three key principles:
- patients at the centre of the NHS
- changing the emphasis of measurement to clinical outcomes
- empowering health professionals, in particular GPs.
The White Paper sets out an ambitious timetable. By April 2012 it proposes:
- establishing the Independent NHS Commissioning Board
- establishing new local authority health and well-being boards
- developing Monitor as an economic regulator.
The new commissioning system is expected to be in place by April 2013, by which time SHAs and PCTs will be abolished.
The NHS Confederation has produced a member briefing on the key points from the White Paper, much of which will have significance for MHN members. You can download a briefing on the White Paper on our latest news web pages
Key points to note include:
- the creation of a public health service and transfer of health improvement functions to local authorities
statutory limits on the powers of the Secretary of State
establishing local health and wellbeing boards to strengthen democratic legitimacy and join up the commissioning of NHS services with social care and health improvement
- reforming the foundation trust model by removing restrictions and enabling new governance arrangements, increasing transparency in their functions, repealing foundation trust deauthorisation and enabling the abolition of the NHS trust model
- the significant powers of the economic regulator including the power to require providers to contribute to a risk pool
- setting out an explicit intention to move towards pay and conditions negotiated by employers and a review of the pension scheme’s impact on the plurality of provision.
From a mental health perspective, our initial analysis of the White Paper highlights the following key issues as having particular relevance to MHN members.
Implications for Mental Health Services
Commissioning
A major implication for MHN members will revolve around how the services they provide are commissioned, with somewhere between £60 to £80 billion of the total NHS budget being transferred to groups of GPs to commission services. The National NHS Commissioning board will be responsible for commissioning certain services, such as national specialised services and regional specialised services as set out in the Specialised Services National Definitions Set.
More information on what services those categories cover can be found on the website for the National Commissioning Group for Highly Specialised Services at http://www.ncg.nhs.uk/. Currently, national specialised services cover areas such as secure forensic mental health service for young people and severe obsessive compulsive disorder and body dysmorphic disorder services. Those that currently come under regional specialised services include a range of mental health services, such as forensic / secure mental health services, specialised mental health services for the deaf, and Tier 4 child and adolescent mental health services.
Choice
Another implication for MHN members is on the extension of choice. The White Paper states that choice of both treatment and provider will be extended into some mental health services from April 2011. In implementing proposals for extending choice, the Department will consult widely. The importance of decision aids to enable effective patient choice is particularly acknowledged for mental health and community services.
Development of currencies and outcome measures
Payment mechanisms will also be further developed. A set of payment by results currencies for adult mental health services will be introduced from 2012/13. There are also plans for developing currencies for child and adolescent services. Payment mechanisms to support the commissioning of talking therapies will also be formulated.
On outcomes, the White Paper states that the criteria utilised within the NHS Outcomes Framework will ensure mental health outcomes are included. The DH will consult on the development of the national outcome goals.
Other key points
Other key points that are of particular note to mental health providers are those around the creation of new further exploration of the potential of personal health budgets, incentives for quality improvement, and a focus on closer working between health and social care. It also says that special statutory arrangements will be made for the three high secure psychiatric hospitals (Broadmoor, Rampton and Ashworth), allowing them to benefit from the independence of foundation status while retaining appropriate safeguards to reflect their role in the criminal justice system.
Mental Health Network support for members
A Confederation briefing setting out the key points of the white paper will be available as soon as possible on 13 July, along with details of an event for member organisations to discuss the implications and help with the transition to the new system.
Further detail is expected later in July in a series of associated publications from the Department of Health.
The MHN will continue to keep members up to date on how those plans will affect mental health services, and will be playing a full part in representing the views of network members in further government consultations.
Our next General Network Meeting is on the 16th September at BMA House. We will be looking more in depth at the implications for mental health services at that event. To book a place contact Christina Heap by email at Christina.heap@nhsconfed.org or telephone on 020 7074 3246.
If you have any questions regarding the White Paper please contact our Policy Manager, Rebecca Cotton by email at Rebecca.cotton@nhsconfed.org or by telephone on 020 7074 3311.