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Archive for the ‘Health and Social Care Bill’ Category

By Alan Maryon-Davis, honorary professor of public health at Kings College London and past president of the Faculty of Public Health

WE love our NHS, despite its failings. We trust it, we depend on it and we cherish its fundamental principles of fairness and universality – free to all at the point of use.

Born out of Beveridge, midwifed by Bevan, the safe arrival of the infant NHS in the aftermath of war was nothing less than a revolution – the sort of massive change that could never happen today. It was huge – so big it dwarfed outer space.

Now, as we all know, the NHS is under threat – weighed down by the ageing population and high-tech hypertrophy, harried by small-state politicians, encircled by drooling marketeers  and asset-strippers.

The NHS is accused of being too monolithic, lumbering and unsustainable. The Government’s response has been to claw back millions of pounds and fire an explosive harpoon into its belly. The 2012 Act has torn into the flesh of the NHS, damaged many of its vital organs and put it on the critical list.

But it’s not dead yet. They have underestimated the power of the people. The NHS is healthcare of the people, by the people, for the people, all for one and one for all. This is why so many of us feel so passionate about it – and why we delighted in seeing it celebrated in the Olympics opening ceremony.

I believe the NHS at 65 is still, fundamentally, in good shape – in spite of all the ‘efficiency savings’, all the sniping and Cassandras, all the barbs, rug-pulling and clattering of bedpans in the corridors of Whitehall. The NHS can be nursed back to full health and vigour. Of course this requires political will – but political will is driven by the power of the people. And people power can be shaped and energised by the advocacy of those of us who feel strongly about defending the NHS and its fundamental principles.

We must seize this 65th birthday celebration to let everyone know that we will fight to make sure the NHS – the real NHS, not just the logo – is here to stay.

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by Daria Kuznetsova, researcher,  New Local Government Network (NLGN)

Local government is once again a major player in the health arena. With a new public health duty and a leading role to play in the new Health and Wellbeing Boards (HWBs), councils have an opportunity to generate much greater efficiency and effectiveness.

Moreover, as this is the first time clinicians, politicians and local government officers have come together, there is a once in a lifetime opportunity to rethink and redefine preventative health interventions to radically improve the health outcomes of the local population. In a recent research report, we began to map out how local government could take up the role of the ‘health improving council’ implied by the recent reforms.

The new arrangements will certainly create opportunities, and there are reasons for optimism: among those involved in the agenda, our research reveals a relatively high degree of confidence (3.85 out of 5) in HWBs. However, it is already evident that creating stronger relationships across an increasingly complex health and social care sector will not be without its challenges. Sixty six per cent of survey respondents said that organisational differences were the most significant factor which might limit the effectiveness of their HWB.

Organisational divisions and territorialism in decision-making and budget-setting will be particularly problematic, particularly where hard choices have to be made to divert limited resources from existing services to new priorities. To encourage honesty in these ‘difficult conversations’,  we recommend HWBs design ‘prenuptial agreements’ illustrating the commitment and contribution each board member is prepared to make to the board.

The effectiveness of HWBs will depend on their ability to engage with a wide variety of external stakeholders, which they can influence only indirectly. However as local government only has soft powers at their disposal, there is a danger of public health not being prioritised by other local agencies.

We propose legislating a “duty to cooperate” with HWBs, similar to that in the Localism Act 2011, for public bodies. We further propose the HWB chair should have a ‘call in’ power to local authority departments commissioning services (for example in relation to the use of CIL) to ensure local authority delivery takes the Joint Health and Wellbeing Strategy into account.

At the heart of the changes lies an opportunity for a new era of public involvement in health services and prevention. By engaging residents, particularly ‘hard to reach’ groups, HWBs will be able to design interventions that meet immediate needs but also reduce demand in the long term. To ensure public engagement is prioritised, we recommend that HWBS should publish an explicit strategy for public involvement in their work.

Our research found that budget pooling is seen as the most effective tool available to ensure effectiveness of HWBs.  However 94 per cent of respondents felt that central government has provided insufficient incentives for integrated working. If local authorities are to succeed in reducing demand for acute services, they will need to shift resources to prioritise preventative measures. We suggest government should create “Health and Wellbeing Deals” whereby HWBs bring forward plans for pooling in exchange for the removal of regulatory or legal barriers to pooling as well as potential top-up funding for pooled budgets from central government.

The reforms in public health offer a real opportunity to reshape public services and drive preventative healthcare into everything local authorities do. However without tougher power for HWBs, they risk becoming a talking shop. We therefore strongly urge the government to legislate for a small number of hard, statutory powers which could turbo charge the new boards and ensure the emergence of a new generation of health improving councils.

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by Professor Allyson Pollock, professor of public health research and policy at Queen Mary, University of London

The Health and Social Care Bill 2011 represents the biggest threat to public health for 60 years and it is time for the public health community to stand up and say so.

Deliberately conceived as an ‘Abdication and Abolition Bill’, the proposed legislation would sever the duty of the Secretary of State to secure and provide comprehensive healthcare throughout England.

Entitlements to health care are to be abandoned in order that a consumer market can be substituted for a needs-based system and, in David Cameron’s words, the NHS turned into a “fantastic business for Britain”.

As these briefings to the House of Lords show, the Bill will destroy the public health foundations of comprehensive healthcare and the ability to gather information and monitor inequalities.

Geographic administrative units – the hallmarks of the NHS – are to be abolished. Whilst commissioner populations will be made up from GP registrations, GP boundaries are being dissolved.  Patient enrolment and disenrollment will lead to unstable denominators and render fair service allocation and planning impossible.

No-one will have ultimate responsibility for ensuring everybody in a geographic area gets access to a GP. Above all, the ability to monitor equity of access within a comprehensive system will be undermined by lack of data and local variations in entitlement.

Public health will be shunted out to local authorities but the resources, functions and services that will go with it are not defined.  It is even impossible to tell the populations for which it will be responsible.

Local authorities and clinical commissioning groups will have enormous freedom to decide what they will and won’t provide and the boundaries between chargeable and non-chargeable services will be blurred and subject to local eligibility criteria.

In place of equity will be service and patient selection by commissioners and service providers intent on managing the financial risks of the marketplace.  Commissioners will be allowed to outsource their functions to healthcare companies that specialize in these techniques.

The marketisation of healthcare will lead to the denial of care on a scale not seen in England since pre-war days.

At a minimum the Bill must be amended so as to restore all the Secretary of State’s duties and functions and the structures of a national public health service.

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by John Middleton, Vice-President of the Faculty of Public Health

The results of our latest member survey show despair, uncertainty and distress about the NHS reforms. We share members’ anger and frustration, reflected in feedback from local boards and committees. The results articulate the possibility of a wholesale departure from the specialty and major risks to the protection and improvement of the public’s health and the services they receive.

Wordcloud: Adjusted responses (phrases/themed/categorized), first 200 responses (max 50 phrases)

Credit: Andrew Hood, using wordle.net

Wordcloud: Adjusted responses (phrases/themed/categorised), from the first 200 responses in the survey (maximum 50 phrases)

As peers continue to debate the reforms, attitudes of public health professionals, and FPH’s leadership, are hardening. Faced with a government which does not seem to value professionalism or standards, it is essential that we continue to fight for the standards, accreditation and regulation of public health. No-one else will – and our partners in the public health national lobby agree with our stance.

Members have broadly supported this direction of travel – until now.  The ignorance and disregard in high places of what public health is and has done over 40 years in the NHS is alarming. FPH continues to hold a strong expectation for:
•    An independent and robust Public Health England;
•    A coherent career and training structure for public health professionals;
•    Protection of terms and conditions of staff;
•    Directors of public health reporting to chief executives of councils,
•    Clarity in the size and applications of the ring fenced budget and
•    Professional regulation for all public health specialists.

These issues were met with welcome support in the House of Lords committee stage.  However, a substantial cadre of our members believe that the public health community must campaign more explicitly against the likely negative health impacts if the reforms go through unchecked.

The Secretary of State has had a duty to ‘provide and secure’ the NHS since it began.   NHS planning has historically relied on regulations and guidance, not legislation.  This enables the NHS to move forward if the Secretary of State is in charge. If not, every line of the Health Bill becomes crucial.

Hard-pressed local authorities will only do what they must by law CCGs also will only do what they are required to do in law. The health system becomes a giant free-for-all; everyone doing the least possible, or the most lucrative and pocketing taxpayers’ cash. Some services may be deemed ‘bad business decisions’ and not be provided.

Where will these be without the Secretary of State’s duty to secure? This is a health insurance versus public health model. It calls into question the ideal of public service with which most of our members entered the NHS. Everyone in public health and health service users should be concerned about that.

As part of this debate, we have invited a range of organisations to contribute to this blog.  It remains open for members’ comments and more formal critiques. We look forward to your contributions here and through your local board members and FLACS.

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