nhs future forum

8/6/2019 NHS Future Forum

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NHSFutureForum

Summaryreportonproposed

changestotheNHS

ProfessorSteveFieldChairman


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Contents

Letter to thePrimeMinister,DeputyPrimeMinisterand

the Secretary of State for Health from the NHS Future

ForumChair

5

TheNHSFutureForumourroleandhowwelistened 14

TheNHSConstitution 19

Integrationandcollaboration 20

Thepublicshealth 22

ThefourcorethemesoftheNHSListeningExercise:

ChoiceandCompetition PublicAccountabilityandPatientInvolvement ClinicalAdviceandLeadership

Education

and

Training

24

26

28

29

Gettingthepaceofchangeright 30

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LettertothePrimeMinister,

DeputyPrimeMinisterandthe

SecretaryofStateforHealth

TheNHShasalwaysbeenthereforme.Ithastakencareofmeand

myfamilywheneverwehaveneededit.Ithasbeenahugeprivilege

toworkasadoctorintheNHSformyentirecareer.Iknowthatits

coreprinciplesandvaluesareasimportantnowastheywerewhenit

waslaunched.Theyhavebecomepartofthefabricofoursociety,

bindingtogetherthepeopleandcommunitiesthatitservesandthe

staffthatworkforit.

Ithas,therefore,beenagreatresponsibilitytoleadthisprocess.AsIhavelistened

overthelasteightweeksIhavedonesowiththeopeningwordsoftheNHS

Constitutionattheforefrontofmymind. Thepowerfulopeningstatement

constantlyremindedmeoftheseriousnessofthetaskweweresetand,more

fundamentally,ofwhattheNHSisstrivingtoachieveeverysingleday:

TheNHSbelongstothepeople.Itistheretoimproveourhealthandwellbeing,supportingustokeepmentallyandphysicallywell,togetbetterwhenweareilland,whenwecannotfullyrecover,tostayaswellaswecantotheendofourlives.Itworksatthelimitsofsciencebringingthehighestlevelsofhumanknowledgeandskilltosavelivesandimprovehealth.Ittouchesourlivesattimesofbasicneed,whencareandcompassionarewhatmattersmost.Theleveloftheengagementwehaveseeninjusteightweekshasbeenstaggering

andhighlightshowimportantthefutureoftheNHSistostaff,patients,citizensand

allthoseorganisationsthatcareaboutitssuccess.Over6,700peoplehaveattended

listeningeventswithmembersoftheNHSFutureForum,3,000commentshavebeen

postedonthewebsite,over25,000peoplehaveemailedusand600peoplehave

takenthetimetocompleteaquestionnaire.Iamclearthatthereasonpeoplehave

beensowillingtoenterintoameaningful,constructiveandinsightfuldialoguewith

usandwitheachotherisnotbecausetheydontbelievetheNHSneedstochange

butbecausetheywantanychangestobetherightonesandtofeelownershipof

them.

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BasedonwhatIhaveheard,mymessagestoyouare:

TheGovernmentsstatedaimofmaking improvement inqualityandhealthcareoutcomestheprimarypurposeofallNHS fundedcare isuniversallysupported.

However,duringourlistening,weheardgenuineanddeepseatedconcernsfrom

NHSstaff,patientsandthepublicwhichmustbeaddressedifthereformsareto

be progressed. If the substantial changes we propose are accepted by

Government,thenIbelievethattheresultingframeworkwillplacetheNHSina

strongpositiontomeetthisobjectiveandtacklethepressingchallenges inthe

yearsahead;

It is right that GPs should take responsibility for the health of their localpopulationsandthefinancialandqualityconsequencesoftheirclinicaldecisions

throughacomprehensivesystemofcommissioningconsortia.But, theycannot

andshouldnotdothisontheirownandmustberequiredtoobtainallrelevant

multiprofessionaladvicetoinformcommissioningdecisionsandtheredesignof

patientpathways;

Servicesmustchange inordertomeettheneedsof localpopulations.Thiswillrequire difficult decisions, especially about the location of some services and

hospitals. These decisions will need to be sensitively handled but must be

clinicallyled;

Theplaceofcompetition shouldbeasa tool for supportingchoice,promotingintegrationandimprovingquality.Itshouldneverbepursuedasanendinitself.

Monitors role in relation to promoting competition should be significantly

diluted;

Thedeclarationof nodecisionaboutme,withoutmemustbehardwired intoevery part of the system from the legislation through to each and every

encounterbetweenapatientandahealthcareprofessional;

TherehasbeentoomuchfocusondifferentpartsofthesystemGPs,hospitals,publichealthand insufficientattentiontohowtheyalljoinuptoprovidethe

integratedcarethatpatientsneed;

BecausetheNHSbelongstothepeopletheremustbetransparencyabouthowpublicmoney isspentandhowandwhydecisionsaremadeandtheoutcomes

beingachievedateverylevelofthesystem;and

The education and training of the healthcare workforce is the foundation onwhichtheNHSisbuiltandthesinglemostimportantthinginraisingstandardsof

care.Moretime isneededtogetthisright theeffectsofmistakesmadenow

willbefeltforageneration.

EverybodyagreesthatwhiletheNHShasimprovedoverthepasttenyears,itcant

standstill.TheNHSmustaddressthechallengesthatlieahead.Itmustcontinuously

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more.Instead,cliniciansaregoingtohavetomakesomedifficultdecisionsonhow

wespendthemoneymoreeffectivelyandimportantlyhownottospendmoneyon

treatmentsthatdontwork.

IhavebeenadoctorintheNHSsince1982andseentheNHSimproveoverthose

years.But,Ibelievethecurrentmodelofcarecannotbesustainedinthefuture.The

NHSoftodayismostlyabouttheprovisionofepisodictreatmentofillnessessuchas

cancerandcardiovasculardisease.Priorityhasbeenonacutehospitalsandproviding

effectiveinterventionsandtreatmentsforpeopleaffectedbythoselifethreatening

conditions.

IbelievethattheNHSmustchange.Itmustreassesstheoldmodelofhospitalbased

care.Ahighprioritynowneedstobegiventomeetingtheneedsoftheincreasing

numbersofolderpeople.Aspeoplegetolder,theywillrequiremoresupportfrom

boththeNHSandsocialcaretoenablethemtoliveindependentlyinthecommunity

foraslongaspossible.

TheNHSwillneedtomovefromfocusingontreatingpeoplewhentheyareacutely

illtofocusingonpreventionandsupportingselfcareaswell. Wewillneedtomove

resourcesawayfromhospitalssothatwecanprovidemorecareinthecommunity

andinpeopleshomes.Manypatientsandhealthcarestaffhavetoldusthatpriority

shouldbegiventoenablingmorepeopletohavetheirwishesgrantedtodieathome

ratherthaninhospital. Toprovidethischoiceforpeopleattheendoflifewill

requireanintegratedapproachinhealthandsocialcarewithgreaterinvolvementof

thethirdsector,includingthehospicemovement.Movingtothenewmodelwill

requireamuchmorecomprehensiveapproachthatimprovesthecoordinationof

servicesforpatientsandtheirrelatives.

Inprimarycareweneedtocontinuetoimproveaccesstoservices,reducevariations

intheirqualityandprovideadditionalservicesthathelptokeeppeopleoutof

hospital.GPs,theirprimarycareteams,socialcareprofessionalsandspecialistsmust

workmuchmorecloselytogetheraspartofextendedteamstoensurethatthecare

providediseffectivelycoordinated.Betterinformationsystemsandthe

developmentofmoreintegratedelectroniccarerecordswillbeamajorenabling

factorforthis.

Togiveclinicianslikemyselftheheadroomtoofferourpatientstheverybestcare

thatwecan,wearegoingtohavetodecidewheretodisinvest,howtobecome

moreefficient,wheretorootoutwasteandtargetourlimitedbudgetsonwherewe

candothemostgoodforthemoneyspent.Weneedtodothisnottoreducewhat

theNHSdoesbuttotakeadvantageofnewopportunitiesforhealthierandlonger

livesthatpreviousgenerationswouldneverhavethoughtpossible.And,weneedto

dothisinpartnershipwiththepatientsandcitizenswearetheretoserve.

Ifwearegoingtoseizetheseopportunitiestheremustbechange.Butanychange

mustbecarefullyguidedbytheenduringvaluesoftheNHS,assetoutinourNHS

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Constitution,andarelentlessfocusonpurposetheprovisionofhighqualitycare

andimprovedoutcomesforpatients.

ItwasencouragingtoreadinlastyearsWhitePaperthattheGovernmentmade

clearthatitwouldbuildonLordDarzisreviewoftheNHSandestablish

improvementinqualityandhealthcareoutcomesastheprimarypurposeofallNHS

fundedcare.Theimportantdefinitionofqualitythathisreportsetout(safety,

effectivenessandpatientexperience)hasbeenincorporatedintotheHealthand

SocialCareBill. TheGovernmenthassincesetoutapowerfulnewaccountability

frameworkfortheNHS,calledtheNHSOutcomesFramework,whichisdesignedtofocusthewholesystemfromtoptobottomontheoutcomesachievedforpatients.

Theseareimportantandpositivestepsforward.

Soifthereisagreementabouttheprinciplesandtheneedforchange,whathasgone

wrong?Atbest,theHealthandSocialCareBillhasreceivedlacklustresupportfrom

manystaffgroups,openhostilityfromothersandhasbeenlambastedinmuchof

thepress.Thisoppositionwasnotmerelypoliticalitstemmedfromgenuinefear

andanxietythatthereformswouldnotdelivertheimprovementsthatweallwant.

Thisfearandmistrustwasexpressedbymanypatientsandstaffthatwemet.Many

toldusthattheyfearedfortheirownjobprospects,othersbecausetheyfearedthat

theirNHSwasabouttobebrokenupandintheirwordsprivatised.

SomeofthisfearwasmisplacedandtheresultofafailurebytheGovernmentto

clearlyexplainhowthestructuralandtechnicaldetailsoftheBillwouldhelptheNHS

improvetodayandtomorrow.Undoubtedly,thedebatehasfocusedtooheavilyon

themeans,withoutaclearenoughlinktotheendstheprovisionofhighquality

careandimprovedoutcomesforpatients.

However,inotherareaswefoundpeoplesconcernstobejustified.Whilsttherewas

neveranyintentiontointroduceamarketinthestyleoftheutilitiessectorinto

healthcare,theBillcontainedinsufficientsafeguardsagainstcherrypickingandwas

notsufficientlyclearthatcompetitionwouldonlyexistwhenitservedtheinterests

ofpatientsnotprofit.Inotherareas,whilstNHSstaffsupportedthegeneralthrustof

thereforms,theywereanxiousthatthedeadlineswouldforcethemtotakeon

responsibilitiesbeforetheyhadtheskillsorcapacitytoundertaketheminawaythat

wouldimprovepatientcare.And,inafewareas,suchastheproposalsforeducationandworkforcetraining,thereweregenuineconcernsthattherewassimplynot

enoughevidenceordetailtojustifysuchradicalchangewheretheconsequencesof

failurearesosignificantandlonglasting.

So,intakingforwardourtask,wehavedoneonesimplething:wehavetakenthe

keybuildingblocksofthereformprogrammeandlookedatthemthroughthelensof

whethertheywillhelporhinderthedeliveryofhighqualitycareandimproved

outcomesforpatients.Wherewehaveidentifiedweaknessesinthelegislative

frameworkorbroaderpolicy,wehaverecommendedchanges.Wheretherehas

been

failure

to

explain,

we

have

sought

to

provide

clarifications

about

the

purpose

aswellasthemechanismsintheBill.Wheretherehasbeengenuineanxietyand

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mistrust,wearerecommendingsafeguardsfortheavoidanceofdoubt.And,where

thecaseforchangehasyettobeproven,wehaverecommendedthatfurtherwork

becarriedout.Atalltimes,thepursuitofhighqualitycareandimprovedoutcomes

forpatientshasguidedusinourrecommendationsandmustbetheguidingprinciple

foranychange,whetheratanationalorlocallevel.

Itwasrighttopauseandreflect.Ithas,however,beenadestabilisingperiodforthe

NHSandanunsettlingtimeforstaffandforpatients.Itistimeforthepausetoend.I

believethattheadviceandrecommendationswepresentinthisreport,ifacted

upon,willhelptheNHStomoveforwardandrefocusitseffortsondelivering

excellenceinpatientcareandbuildingtheNHSofthefuture. Thecore

recommendationsofthefullNHSFutureForumare:

TheenduringvaluesoftheNHSandtherightsofpatientsandcitizensassetoutintheNHSConstitutionareuniversallysupportedandshouldbeprotectedand

promotedatalltimes.TheBillshouldbeamendedtoplaceanewdutyonthe

NHSCommissioningBoardandcommissioningconsortiatoactivelypromotethe

NHSConstitution.Inaddition,Monitor,theCareQualityCommission,theNHS

CommissioningBoardandcommissioningconsortiashouldallsetouthowthey

aremeetingtheirdutytohaveregardtotheNHSConstitutionintheirannual

reports.

TheNHSshouldbefreedfromdaytodaypoliticalinterferencebuttheSecretaryofStatemustremainultimatelyaccountablefortheNationalHealth

Service.TheBillshouldbeamendedtomakethisclear.

Patientsandcarerswanttobeequalpartnerswithhealthcareprofessionalsindiscussionsanddecisionsabouttheirhealthandcare.Citizenswanttheir

involvementindecisionsaboutthedesignoftheirlocalhealthservicestobe

genuine,authenticandmeaningful.Therecanbenoplacefortokenismor

paternalism. Thedeclarationofnodecisionaboutme,withoutmemust

becomeareality,supportedbystrongerandclearerdutiesofinvolvement

writtenintotheBillfocusedontheprinciplesofshareddecisionmaking.

BecausetheNHSbelongstothepeopletheremustbetransparencyabouthowpublicmoneyisspentandhowandwhydecisionsaremade.TheBill

shouldrequirecommissioningconsortiatohaveagoverningbodythatmeetsin

publicwitheffectiveindependentrepresentationtoprotectagainstconflictsof

interest.MembersofthegoverningbodyshouldabidebytheNolanprinciplesof

publiclife.AllcommissionersandsignificantprovidersofNHSfundedservices,

includingNHSFoundationTrusts,shouldberequired,asaminimum,topublish

boardpapersandminutesandholdtheirboardmeetingsinpublic.Foundation

Trustgovernorsmustbegivenappropriatetrainingandsupporttooverseetheir

Trustsperformanceuntilgovernorshavethenecessaryskillsandcapabilityto

takeonthisroleeffectively,Monitorscomplianceroleshouldcontinue.

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GPs,specialistdoctors,nurses,alliedhealthprofessionalsandallotherhealth

andcareprofessionalsstatethattheremustbeeffectivemultiprofessional

involvementinthedesignandcommissioningofservicesworkingin

partnershipwithmanagers.Arrangementsformultiprofessionalinvolvementin

thedesignandcommissioningofservicesareneededateverylevelofthe

system.TheBillshouldrequirecommissioningconsortiatoobtainallrelevant

multiprofessionaladvicetoinformcommissioningdecisionsandthe

authorisationandannualassessmentprocessshouldbeusedtoassurethis.In

supportofthis,thereshouldbeastrongroleforclinicalandprofessional

networksinthenewsystemandmultispecialityclinicalsenatesshouldbe

establishedtoprovidestrategicadvicetolocalcommissioningconsortia,health

andwellbeingboardsandtheNHSCommissioningBoard.

Managershaveacriticalroletoplayinworkingwithandsupportingcliniciansandclinicalleaders.Experiencedmanagersmustberetainedinordertoensurea

smoothtransitionandsupportclinicalleadersintacklingthefinancialchallenges

facingtheNHS.

Thereshouldbeacomprehensivesystemofcommissioningconsortiabuttheyshouldonlytakeontheirfullrangeofresponsibilitieswhentheycan

demonstratethattheyhavetherightskills,capacityandcapabilitytodoso.

Theassessmentoftheskills,capacityandcapabilityofcommissioningconsortia

mustbeplacedattheheartofauthorisationandannualassessmentprocess.

Wherecommissioningconsortiaarenotready,theNHSCommissioningBoard

shouldcommissionontheirbehalfbutprovideallnecessarysupporttoenable

thetransferofpowertotakeplaceassoonaspossible.

Patientswanttohaverealchoiceandcontrolovertheircarethatextendswellbeyondjustchoiceofprovider. BuildingontheNHSConstitution,theSecretary

ofStateshould,followingfullpublicconsultation,giveachoicemandatetothe

NHSCommissioningBoardsettingouttheparametersforchoiceandcompetition

inallpartsoftheservice.ACitizensPanel,aspartofHealthwatchEngland,

shouldreporttoParliamentonhowwellthemandatehasbeenimplemented

andfurtherworkshouldbedonetogivecitizensanewRighttoChallengepoor

qualityservicesandlackofchoice.

Competitionshouldbeusedasatoolforsupportingchoice,promotingintegrationandimprovingqualityandmustneverbepursuedasanendin

itself.Monitorsroleinrelationtocompetitionshouldbesignificantlydilutedin

theBill.Itsprimarydutytopromotecompetitionshouldberemovedandthe

BillshouldbeamendedtorequireMonitortosupportchoice,collaborationand

integration.

PrivateprovidersshouldnotbeallowedtocherrypickpatientsandtheGovernmentshouldnotseektoincreasetheroleoftheprivatesectorasanend

initself.Additionalsafeguardsshouldbebroughtforward.

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ThedutiesplacedontheSecretaryofState,theNHSCommissioningBoardand

commissioningconsortiatoreducehealthinequalitiesarewelcome.Thesenow

needtobetranslatedintopracticalaction.TheMandatefortheNHS

CommissioningBoard,theoutcomesframeworksfortheNHS,publichealthand

socialcare,commissioningplansandothersystemleversandincentivesmustall

beusedtohelpreducehealthinequalitiesandimprovethehealthofthemost

vulnerable.

LocalgovernmentandNHSstaffseehugepotentialinhealthandwellbeingboardsbecomingthegeneratorsofhealthandsocialcareintegrationandin

ensuringtheneedsoflocalpopulationsandvulnerablepeoplearemet.The

legislationshouldstrengthentheroleandinfluenceofhealthandwellbeing

boardsinthisrespect,givingthemstrongerpowerstorequirecommissionersof

bothlocalNHSandsocialcareservicestoaccountiftheircommissioningplans

arenotinlinewiththejointhealthandwellbeingstrategy.

Betterintegrationofcommissioningacrosshealthandsocialcareshouldbetheambitionforalllocalareas.Tosupportthesystemtomakeprogresstowards

this,theboundariesoflocalcommissioningconsortiashouldnotnormallycross

thoseoflocalauthorities,withanydepartureneedingtobeclearlyjustified.The

GovernmentandtheNHSCommissioningBoardshouldenableasetofjoint

commissioningdemonstrationsitesbetweenhealth,socialcareandpublichealth

andevaluatetheireffectiveness.

MostNHSstaffareunfamiliarwiththeGovernmentsproposedchangestotheeducationandtrainingofthehealthcareworkforce.Thosewhoareawarefeel

thatmuchmoretimeisneededtoworkthroughthedetail.Theultimateaim

shouldbetohaveamultidisciplinaryandinterprofessionalsystemdrivenby

employers.Therolesofthepostgraduatemedicaldeaneriesmustbepreserved

andaninterimhomewithintheNHSfoundurgently.Theprofessional

developmentofallstaffprovidingNHSfundedservicesiscriticaltothedelivery

ofsafe,highqualitycarebutisnotbeingtakenseriouslyenough.TheNational

QualityBoardshouldurgentlyexaminehowthesituationcanbeimprovedand

theconstitutionalpledgeto'provideallstaffwithpersonaldevelopment,access

toappropriatetrainingfortheirjobsandlinemanagementsupporttosucceed'

behonoured. Improvingthepublic'shealthiseveryone'sbusinessbutshouldbesupported

byindependent,expertpublichealthadviceateverylevelofthesystem.In

ordertoensureacoherentsystemwideapproachtoimprovingandprotecting

thepublic'shealth,alllocalauthorities,healthandsocialcarebodies(including

NHSfundedproviders)mustcooperate.Atanationallevel,toensurethe

provisionofindependentscientificadvicetothepublicandtheGovernmentis

notcompromisedweadviseagainstestablishingPublicHealthEnglandfully

withintheDepartmentofHealth.

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Clinicalleaders,managersandallthosewhocareaboutthesuccessoftheNHS

agreethatquality,safetyandmeetingthefinancialchallengemusttake

primacyandthepaceoftransitionshouldreflectthis.Toensurefocused

leadershipforquality,safetyandthefinancialchallenge,theNHSCommissioning

Boardshouldbeestablishedassoonaspossible.

Iwouldliketothankthethousandsofindividualsandorganisationsthathavemade

theircontributiontotheworkoftheNHSFutureForum,andtothe44membersof

theForumitself.Withouttheirgenuinecommitmentandserioushardwork,itwould

nothavebeenpossibletowritethisreport.

ItisnowtimetomoveonbuttheactivelisteningmustcontinuetheNHSFuture

Forumstandsreadytohelplistenandtoadvise.

ProfessorSteveFieldCBEFRCGPFRCP

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TheNHSFutureForum

ourroleandhowwelistened

Introduction

On6April,theGovernmentannouncedthatitwouldtakeadvantageofanatural

breakinthelegislativetimetabletopause,listenandreflectonmodernisation

plansandbringaboutimprovementstotheHealthandSocialCareBillwhere

necessary.

AneightweekNHSListeningExercisewasannounced.Theobjectivewasnotto

repeattheformalpublicconsultationswhichhadalreadytakenplace,buttoreflect

ontheareaswhichhadpromptedthemostheateddiscussionanddebateandbring

forwardimprovementstothelegislationwherenecessary.Thefourcorethemesof

theNHSListeningExercisewere:

Choiceandcompetition Clinicaladviceandleadership Patientinvolvementandpublicaccountability EducationandtrainingThe

NHS

FutureForum

TheNHSFutureForumwasestablishedasanindependentadvisorypaneltodrive

engagementaroundthelisteningexercise,listentopeoplesconcerns,reportback

onwhatweheardandofferadvicetothePrimeMinister,DeputyPrimeMinisterand

theSecretaryofStateforHealthonhowtheGovernmentsmodernisationplansfor

theNHSmightbeimproved.

TheForum,chairedbyProfessorSteveFieldimmediatepastChairmanoftheRoyal

CollegeofGPs,bringstogether45individualsfromadiverserangeofbackgrounds

including

frontline

clinicians,

healthcare

managers

and

representatives

from

the

voluntarysector,localgovernmentandpatientbodiesamongstothers.

AsaForumwedividedourselvesintofourworkinggroupstotackleeachofthecore

themesandcommittedtoundertakeanintensiveperiodoflisteningandreflection.

Eachofthesegroupswasledbyaworkstreamlead:

SirStephenBubb,leadforChoiceandCompetition(ChiefExecutiveoftheAssociationofChiefExecutivesofVoluntaryOrganisations)

DrKathyMcLean,leadforClinicalAdviceandLeadership(MedicalDirectorofNHSEastMidlands)

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JulieMoore,leadforEducationandTraining(ChiefExecutiveofUniversity

HospitalsBirmingham)

GeoffAlltimes,leadforPatientInvolvementandPublicAccountability(ChiefExecutiveofHammersmithandFulhamBoroughCouncil)

Thetimescalesforthelisteningperiodweretightandchallengingwithmanyofus

workingfulltime,includingmanyaspractisingclinicians.However,weworkedasa

grouptomaximisetheengagementopportunitiespresentedtous.Wealso

mobilisedexistingnetworks,eventsandusednewwaysofengagementsuchas

webchatsandblogstoreachkeyaudiences.

Wecametogetherasawholeatregularintervalstoshareandcrossreferencekey

themescomingoutoftheexerciseandworkedtogethertodevelopour

recommendations.

LordVictorAdebowale,ChiefExecutive,TurningPoint DrCharlesAlessi,SeniorGPPartner,TheChurchillPractice GeoffAlltimes,ChiefExecutive,LondonBoroughof

HammersmithandFulham

DrFrankAtherton,President,AssociationofDirectorsofPublicHealth

VickyBailey,ChiefOperatingOfficer,Principia,PartnersinHealth,Nottingham

SallyBrearley,Patientrepresentative SheilaBremner,ChiefExecutive,MidEssexPrimaryCare

Trust

DrSimonBrown,HuntingtonGPConsortiapathfinderlead SirStephenBubb,ChiefExecutive,AssociationofChiefExecutivesofVoluntaryOrganisations

ProfessorHilaryChapman,ChiefNurse,SheffieldTeachingHospitals

hiefExecutive,RaceEqualityFoundationRatnaDutt,C ofCamdenMoiraGibb,ChiefExecutive,LondonBorough ,MarkGoldring ChiefExecutive,Mencap

sultantUrologicalSurgeon,Royalers

Associationof Hallett,ChiefExecutive,MarieCurie vidKerr,ProfessorofCancerMedicine,Oxford ,IntensiveCareNurse,Imperial tt,ConsultantPsychiatrist,OxleasNHS

ChrisLong,ChiefExecutive,HullPCT

ChiefExecutive,Brighton&SussexUniversity

OrthopaedicSurgeonandCo

;andChair,Lambeth

Professor

son,President,Royal irJohnTooke,ViceProvost,University ofMidwifery,PortsmouthHospitalsNHS

PaulFarmer, ChiefExecutive, MindMrDerekFawcett,ConBerkshireNHSFoundationTrust

ProfessorDavidFish,ManagingDirector,UCLPartnPeterHay,Strategic

Director,AdultsandCommunities,

BirminghamCityCouncil;andVicePresident,DirectorsofAdultSocialServices

ThomasHughesCancerCare

Prof.DaUniversity

JoannaKillian,ChiefExecutive,EssexCountyCouncilClareLeonVillapalosCollegeHealthcareNHSTrustDrPaulLellioFoundationTrust

MalcolmLoweLauri,ChiefExecutive, UniversityHospitalsofLeicesterNHSTrust

BillMcCarthy,ChiefExecutive, YorkshireandHumberStrategicHealthAuthority

ClaireMarshall,HeadofProfessions,HeatherwoodandWexhamParkHospitalsNHSFoundationTrust

AnthonyMcKeever,ChiefExecutive,BexleyCareTrust DrKathyMcLean,MedicalDirector,NHSEastMidlands JulieMoore,ChiefExecutive,UniversityHospitals

stBirminghamNHSFoundationTru

DrPeterNightingale,President,RoyalCollegeofAnaesthetists

MrDermotORiordan,MedicalDirectorandConsultantolkHospitalNHSTrustSurgeon,WestSuff

DrNitiPall,PractisingGP,Smethwick;ChairandClinicalLead,epathfinderconsortiaWestMidlandsThirdWav

ecutive,LeedsCityCouncilTomRiordan,ChiefEx Cllr.DavidRogers,Chair,LocalGovernmentAssociation

CommunityHealthandWellbeingBoard

DuncanSelbie,HospitalsTrust

MrMatthewShaw,founder,RemedyUK

AshSoni,Pharmacist,LambethProfessionalExecutiveCommittee

ProfessorJimmySteele,HeadofSchoolandofOralHealthServicesResearch,NewcastleUniversity

ProfessorTerenceStephenCollegeofPaediatricsandChildHealth

JeremyTaylor,ChiefExecutive,NationalVoicesProfessorSCollegeLondon

DrRobertVarnam,PractisingGP,ManchesterGillWalton, DirectorTrust

MrFrancisWells, diothoracicSurgeon,PapworthHospitalNHSFoundationTrust

ConsultantCar

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NHSFutureForumMembers

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Howwelistened

Facetofacelisteningwemetwithalargenumberofpeoplefacetofacetohear

firsthandviews,concernsandsolutionsofpatients,thepublic,NHSstaffand

stakeholders.

In

total,

we

met

with

over

6,700

people

in

a

series

of

over

200

listening

eventsandmeetings.Thesemeetingsandeventsincluded:

Meetingsandeventswithover250nationalstakeholderorganisationsthroughproactiveengagement,anumberofnationalstakeholdersofferedto

hostorreviseexistingagendastoaccommodatelisteningeventswiththeir

membersandrepresentativesinordertofeedtheirviewsintothelistening

exercise.Theseorganisationsincludedpatientgroups,professionalbodies

andunions,thirdsectorgroups,aswellaslocalgovernment,regulatorsand

theindependentsector.

Regionallisteningeventsandmeetings StrategicHealthAuthorities(SHAs)acrossthecountrysupportedthelisteningexercisebyencouragingstaff,

communitiesandstakeholdersatregionalandlocallevelstosharetheir

viewsonline.Furthermore,theSHAsusedseveralhundredeventsand

meetingstoengagepeopleintheexercise.Weattendedanumberofthese

meetingsacrossthecountryandthethemesfromthemeetingswerecollated

regionallyandthensharedwiththeForum.

PatientandpublicengagementmembersofLocalInvolvementNetworks(LINks)wereinvitedtotwonationallisteningeventswiththeForumtofeedinviewsfromtheircommunities.Furthermore,regionalrepresentativesfrom

patientorganisations,thethirdsectorandLINkswereinvitedtoaseriesof

nineregionaleventshostedbyRegionalVoices.Over100patientsand

patientrepresentativeswithlongtermconditionswerealsoinvitedtoa

nationalpatienteventhostedbyRethink.

Onlineengagement

PeoplewereencouragedtosharetheirviewswiththeNHSFutureForumina

numberofwaysincluding:

WebchatswetookpartinaseriesofwebchatswiththepublicthroughtheDepartmentofHealthmodernisationsite,theGuardiansiteandtheBritish

MedicalAssociationsite.

Commentsviathemodernisationwebsitemembersofthepublicandstakeholderswereinvitedtoleavecommentseitherpubliclyorprivatelyvia

themodernisationwebsite.Morethan3,000commentswerereceived

throughthewebsite.

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NHSFutureForuminboxmembersofthepublicandstakeholderswere

alsoinvitedtoemailcommentsandviewpointsviaadedicatedinboxifthey

preferred,whichweresharedwiththeForum.Over25,000emailswere

receivedand600peopletookthetimetocompleteaquestionnaire.Itis

importanttopointoutthatalargeproportionoftheseemailswere

generatedbycampaigngroupsandthatasaresult,manyofthemcontained

similarwording.Nonetheless,ourapproachisthatifanindividualseesfitto

takepartinsuchcampaigns,theiremailisfullyconsidered.

Socialnetworks manyofusalsomadeuseofsocialnetworkroutessuchasTwittertopromotewaystogetinvolved.

TheNHSFutureForumisverygratefultothethousandsofpeoplewhotookthetime

totalktousandtosubmittheirviews.

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Integrationandcollaboration

OneofthewaystheNHScandelivercarethatupholdstheprinciplesandvaluesof

theNHSConstitutionisincreasedintegrationofcarearoundtheneedsofthepatient.Thiswasacorethemeinmanyofourdiscussions.

TheGovernmentsproposalsfortheNHShaveattractedmanyclaimsthattheywill

createfragmentationandundermineintegrationofservicesaroundtheneedsof

patientsandindividuals.Whatisalsoclearisthatservicesundertheexistingsystem

arecurrentlyhighlyfragmentedacrosstheNHS,publichealthandsocialcare;and

withintheNHS,betweenprimary,secondaryandtertiarycare.Regardlessof

whetherourdiscussionswerefocussedontheissueofpublicaccountabilityand

patientinvolvement,competitionandchoiceorclinicaladviceandleadership,

concerns

around

integration

came

up

time

and

time

again.

The

importance

of

collaborationandintegrationbetweendifferentcaresectorsandcaresettingsare,

therefore,strongthemesineachoftheseparateworkstreamreportsandimportant

recommendationsforstrengtheningcollaborationandintegrationareputforward.

Therearealreadyexamplesofsuccessfulintegrationofhealthandsocialcareat

differentlevelsintheNHS.Whiletherearemanyexamplesinlocalcommunitiesof

multidisciplinaryteamsworkingtogethertomeettheneedsofindividualpatients

andcarers,therearealsoexamplesofintegratedservicesatalargerscalefor

exampleinstrokecareinLondon,diabetesinBoltonandinthecareofolderpeople

inTorbay.Wehavelearntthatitdoesntalwaysneedamergerofservicestodeliver

bettercarebutprovidersworkingtogether,forexample,innetworkstocoordinate

aroundtheneedsofpatients.

However,legislatingordictatingforcollaborationandintegrationcanonlytakeusso

far.Formalstructuresarealltoooftenpresentedasanexcuseforfragmentedcare.

Therealityisthattheprovisionofintegratedservicesaroundtheneedsofpatients

occurswhentherightvaluesandbehavioursareallowedtoprevailandthereisthe

willtodosomethingdifferent.Weneedtomovebeyondarguingforintegrationto

makingithappen,whilstexploringthebarriers.Wewouldthereforeexpecttosee

theNHSCommissioningBoardactivelysupportingthecommissioningofintegrated

packagesofcarebuildingontheideasthatmanyorganisations,includingtheKings

FundandtheNuffieldTrust,havepresentedaspartoftheListeningExercise.

Wehaveseenthatmanylocalareasacrossthecountryarepressingaheadwith

strengthenedpartnershiparrangements. Morethanfourineveryfiveuppertier

localauthoritiesinEnglandareearlyimplementersforGovernmentsproposed

healthandwellbeingboards.Thisdemonstratesenthusiasmfromcouncilsandtheir

NHSpartnerstoworktogethertoimprovehealthandcareoutcomesforlocal

communities.Theseearlyimplementershavetoldustheyseethisasanopportunity

toovercomehistoricalblockstoinnovation,buildingbetterservicesthatarejoined

uparoundtheneedsoflocalpeopleandcommunities,toaddresshealthinequalities

andtotacklethewiderdeterminantsofhealth. Thereappearstobeagrowing

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consensusthathealthandwellbeingboardshavethepotentialtoprovidean

opportunityforlocalpartnerstoworkwithcommunitiesandtodeliverrealbenefits

inawaythattheyhaventbeenabletoachieveunderpreviousarrangements.

Wehavealsoheardofmanyexamplesofcommissioningconsortiapathfinders

testingoutthenewcommissioningarrangementsanddemonstratinghowclinical

leadershipofcommissioningcanimprovecare,reducewasteanddeliverbetter

outcomesandvalue. Manypathfindershavehighlightedthebenefitsofstronger

collaboration,bethatbetweenprimaryandsecondarycare,orlocalpartnership

workingwithlocalauthorities,butalsotheimportanceofengagementwithpatients

andthepublic. BassetlawCommissioningOrganisationisworkinginpartnership

withitslocalNHSFoundationTrusttoimproveacutecareprocessesanddischarge

systemtoimprovepatientcare. IntegratedCareCommissioning,apathfinderin

SouthBirmingham,issettinguppartnershipswithlocalauthorityandthirdsector

organisationstodelivernewservicesforpatients.Othersarelookingatreferral

managementthroughpeerreview. Whatisclearisthattheyareallfocusedonreally

makingadifferencefortheirpatients.

Collaborationisessentialforeffectiveclinicalnetworksandthedeliveryofhigh

qualityeducation,trainingandresearch.Itisalsothemostclinicallyandcost

effectivewayofdeliveringhighqualitycareforthosechildrenandadultswithco

morbiditiesandlongtermconditions.Inshort,collaborationisessentialforthe

deliveryofhighqualityhealthandcareinthefutureNHS.

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Atanationallevel,weheardaboutthevalueofastrong,integratedpublichealth

serviceencompassingthethreedomainsofpublichealth:healthprotection,health

improvementandhealthservices.But,wealsoheardstrongconcernsfromthe

publichealthcommunitythattheorganisationalformshouldnotcompromisethe

abilitytoprovideindependentscientificadvicetothepublicandtheGovernment.

WearenotconvincedthatthecurrentproposalstoplacePublicHealthEnglandfully

withintheDepartmentofHealthwillachievethenecessarylevelofindependence

and,withthat,publictrustandconfidence.Wethereforerecommendagainstthis.

RegardlessofthefinalorganisationalformofPublicHealthEngland,itwillbevitalfor

ittoworkcloselywiththeNHSCommissioningBoardinordertoeffectivelydeliver

againstallthreedomainsofpublichealth.

TheGovernmentsfocusoninclusionhealthandreducinghealthinequalitieshasalso

beenwarmlywelcomed.ThedutiestheBillalreadyplacesontheSecretaryofState,

theNHSCommissioningBoardandcommissioningconsortiawillallneedtranslating

intopracticalactionthroughthemandate,theoutcomesframeworksfortheNHS,

publichealthandsocialcare,commissioningplansandothersystemleversinorder

toreducehealthinequalitiesandimprovethehealthofthemostvulnerable.

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ThefourcorethemesoftheNHS

ListeningExercise

ChoiceandCompetition

Choiceandcompetitionhasprobablybeenthemostcontroversialareaofthe

Forumsworkandhaspromptedverystrongviews. Forsome,theGovernments

proposalsrepresentanattackonthecorevaluesoftheNHS. Forothers,theyare

theonlymeansofensuringthattheNHScanbeprotectedandsustainedintothe

future. Itisunfortunatethatmuchofthepublicdebatehasbecomepolarised

aroundthesepositionsandtheChoiceandCompetitiongroupsoughttomove

beyondtheseextremestohearwhatpeoplesviewswereabouttheimpactthatchoiceandcompetitionwouldhaveintheNHS.

Whilsttherewereawidevarietyofdiscussions,thereweresomethemesthatcame

uptimeandtimeagain:WhatdoeschoiceactuallymeanintheNHS? WhereandwhenshouldcompetitionbeappliedintheNHS? WhatroleshouldtheprivatesectorhaveintheNHS?InlookingatwhatchoiceintheNHSmeans,theForumisclearthat,inlinewiththe

NHSConstitution,choicemustbemorethanjustchoiceofprovider. Severalofthe

responses

we

received

through

the

website

commented

that

people

were

more

worriedaboutthequalityandsafetyoflocalservicesthanbeingabletochoose

wheretogo.

Itisabsolutelyrightthatpeopleshouldhavetheconfidencethattheirlocalservices

aresafe. But,weareclearthatchoicecanhelpsupportbetterqualityandmore

integrationbetweenhealthandsocialcare. Itisalsotruethatchoiceofwheretogo

isnotalwaysrelevant,forexampleinanemergencytheparamedicswillnot

normallybeabletoaskyouwhereyouwanttogo.However,thatshouldnotmean

thatsomeoneshouldnothavechoicearoundtheirtreatment. Thereisastronglink

herewiththereportonPatientInvolvementandPublicAccountabilityasmore

choiceispartoftheshareddecisionmakingethos.

Therearepartsofthesystemthatareofferingpeoplechoicenow,butmoreneeds

tobedonetodeliverrealchoice. Wethereforerecommendthatthereshouldbea

clearerchoiceoffer,setoutinachoicemandateasacorepartoftheoverall

mandatethattheHealthandSocialCareBillsaystheSecretaryofStateshouldgive

totheNHSCommissioningBoard. Allplayersinthesystemshouldthenbeheldto

accountfordeliveringthisoffer. Wealsorecommendastrongerpushtooffer

personalhealthbudgetswheretheseareappropriate.

Perhapsthemostcommonlydiscussedissuewaswhatthepracticalimplicationsof

theBillwereforcompetitionintheNHS.Therewasagreatdealofconfusionabout

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whereandwhenitwouldbeapplied,andfearsthatcompetitioncouldblock

attemptstointegratecarearoundthepatient,andthatMonitorwouldapply

competitionlawtopromotecompetitionabovepatientcare.Competitionalready

existsinthehealthservice,andtheForumisconvincedthatithasaplaceinenabling

choiceandimprovingquality.But,itwillnotbeappropriateeverywhere. The

currentpolicyisnotclearenoughaboutthis. Wehaveheardmanypeoplesaying

thatcompetitionandintegrationareopposingforces. Webelievethisisafalse

dichotomy. Integratedcareisvital,andcompetitioncanandshouldbeusedby

commissionersasapowerfultooltodrivethisforpatients.

Thereneedtobechangestothecurrentplanstoputstrongersafeguardsinplace

againstthemisuseofcompetition.And,theremustbemuchgreaterclarityonwhere

competitionwouldbeapplied. Mostimportantly,theBillshouldbechangedtobe

veryclearthatMonitorsprimarydutyisnottopromotecompetition,buttoensure

thebestcareforpatients.Aspartofthis,theymustsupportthedeliveryof

integratedcare.

ThereportalsorecommendsthatthereshouldthisinstitutionaldutyonMonitorto

promotecompetitionisreplacedwithanewrightforpatientstherightto

challengecommissionersatlocallevelwheretheyfeelthatchoicedoesnotexistand

wheretheyfeelthatservicesarenotgoodenough.Furtherpolicyworkisneededto

ensurethisrighttochallengewillleadtorealchange,drivenbypatientsandcitizens.

TheForumheardrealconcernsabouttheinvolvementoftheprivatesectorand

whethertheNHSwasbeingprivatised. Itisclearthatpeoplearegenuinelyworried

thatpoliciessuchasAnyQualifiedProviderwillallowtheprivatesectortoget

involvedinlargepartsoftheNHS. Thisfearoverlooksthefactthatcharitiesandthe

voluntarysectorwillalsobeabletotakeadvantageofAnyQualifiedProviderandit

couldallowsmallerlocalorganisationstoofferservicesthattrulyreflecttheir

communitiesneeds. Thereneedstobeawayofenablingnew,innovativeservices

thatwillofferwhatthepatientneeds.But,theForumisveryclearthattheNHS

shouldnotbeprivatised.

Peoplewereworriedthattheprivatesectorwillcomeinandcherrypickprofitable,

lowriskpatients,leavingthecomplexandexpensivepatientstoNHSservices. This

couldpotentiallymeanthattheNHSorganisationcouldfindthatsomeclinical

servicesbecameunviable.Itisclearthatmoreneedstobedonetoensurethat

cherrypickingdoesnotunderminethequalityofservicesthatpatientshaveaccess

tolocally.

AsthefullreportonChoiceandCompetitionconcludes,ifcompetitionisused

effectivelyandproperlyregulated,wedonotbelieveitthreatensthefundamental

principleofanNHSthatisuniversalandfreeatpointofdelivery.Thereversemay

wellbetrue;thatithelpsprotectthatintothefuture. Therecommendationsfrom

thisworkstreamareintendedtohelpmovethedebatefromwhetherornot

competitionworkstohowbesttomaximisethebenefitswhilstminimisingtherisks.

Readthefullreportofthechoiceandcompetitiongroupatwww.dh.gov.uk/nhsfutureforum

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Wealsoheardhowpatientandpublicinvolvementinthedesignofcarepathways

andstrategiccommissioningdecisionsateverylevelwascriticalforpeople. Health

andwellbeingboardsmusthaveakeyroletoplayinpromotingthislocally.Wealso

recommendthatthereshouldbeindependentrepresentationoncommissioning

consortiagoverningbodieswithspecificresponsibilityforensuringthattheirdutyto

involveiseffectivelyfulfilled.

TheForumalsoheardconcernsaboutwhetherthenewsystemwouldhavethe

appropriateaccountabilitymechanismsatlocalandnationallevels,andsufficient

safeguardsagainstconflictsofinterest.Althoughmanywelcomedtheconceptofthe

healthandwellbeingboard,theywerealsodisappointedatthelackofpowergiven

totheseboardstodrivecooperationandintegrationofservicesatalocallevelandin

theinterestsoflocalpopulations.

Wefirmlybelieveinthepotentialofhealthandwellbeingboardsandhaveoutlined

ourvisionthattheyarethefocalpointforlocaldecisionmakingaboutthe

commissioningofhealthandcareservices,throughjointdevelopmentoftheirhealth

andwellbeingstrategies. Toensurethestrategiesaredelivered,werecommend

thathealthandwellbeingboardsroleshouldbestrengthened.Theyshouldagree

commissioningplans,beabletoreferconcernsaboutcommissioningconsortias

commissioningplanstotheNHSCommissioningBoardandcontributetotheirannual

assessment.

Theremustbetransparencyandopennesswherevertaxpayersmoneyisbeing

spent,andallaccountableindividualsshouldabidebytheNolanprinciplesfor

conductinpubliclife. Commissioningconsortiashouldnotbegiventotalfreedomto

determinetheirowngovernancearrangementswerecommendthattheymustata

minimumhaveagoverningbody,withindependentmembership,whichholds

meetingsinpublicandconsultspubliclyoncommissioningplans.Thesesafeguards

willhelpsecurethebestoutcomesforcommunitiesandhelpguardagainstany

conflictsofinterest.

Finally,atanationallevel,thereneedstobeabsoluteclaritythattheSecretaryof

StateforHealthisultimatelyaccountabletoParliamentforacomprehensivehealth

servicearesponsibilityagainstwhichheshouldannuallyreport.Thisistoo

fundamentalaprincipleonwhichtoallowanyambiguity.

Readthefullreportofthepatientinvolvementandpublicaccountabilitygroupatwww.dh.gov.uk/nhsfutureforum

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ClinicalAdviceandLeadership

ThemostcommonconcernthattheForumheardonthisthemewasthatGPsleading

commissioningdecisionsaspartofcommissioningconsortiawouldnotinvolve

otherswithacontributiontomaketoimprovinghealthandcareservices.Some

groupsfeltthesolutionwastohaveaseatonthegoverningbodiesofcommissioning

consortiatorepresentotherprofessionalgroups.

TheClinicalAdviceandLeadershipreportsaysthattheremustbegenuinemulti

professionalinvolvementandleadershipatalllevelsinthesystem.Wecallfor

strengtheneddutiesoncommissioningconsortiatosecuremultiprofessionalinput

tothecommissioningprocessandfortheauthorisationandannualassessment

processtobeusedtoassurethis.Assessmentoftheskills,capacityandcapabilityof

commissioningconsortiashouldbeplacedattheheartoftheauthorisationand

annualassessmentprocess.Wherecommissioningconsortiacannotdemonstrate

readinesstotakeontheirnewresponsibilitiestheyshouldnotbeallowedtodoso.

Multiprofessionalinvolvementandleadershipshouldbevisiblystrengthenedatall

levelsinthesystem.Thereshouldbeastrongroleforclinicalandprofessional

networksinthenewsystemandmultispecialityclinicalsenatesshouldbe

establishedtoprovideadvicetolocalcommissioningconsortia,healthandwellbeing

boardsandtheNHSCommissioningBoardandtoprovideaforumforcrossspecialty

collaboration,strategicadviceandinnovation.TheClinicalAdviceandLeadership

reportalsocallsformultiprofessionalinvolvementtobeembeddedwithintheNHS

CommissioningBoardandforindependentpublichealthadviceandexpertisetobe

present

at

every

level

of

the

system.

Continuingprofessionaldevelopment(CPD)isessentialtoenableNHSstaffto

continuallyimproveandleadershipdevelopmentisneededsupportthosetakingon

newrolesandresponsibilities.Weheardconcernsaboutthehugevariationinthe

provisionofCPDacrosstheNHSandhowtheprofessionaldevelopmentofallstaff

providingNHSfundedservicesiscriticaltothedeliveryofsafe,highqualitycare.We

recommendthattheNationalQualityBoardshouldexaminehowthesituationcan

beimprovedandtheconstitutionalpledgeto'provideallstaffwithpersonal

developmentandaccesstoappropriatetrainingfortheirjobsbehonoured.Evidencebasedcommissioningisacrucialpartofeffectiveclinicaladviceandleadership.Peoplewantedtoseebetterinformationsystemsandbetterdataabout

outcomes.We,therefore,highlighttheimportanceofinformationsystemsandflows

toenableseamless,integratedpatientcare.Thereportrecommendsthat

commissionersshouldrequireimprovedcollectionanduseofdataaboutoutcomes

ofcaretoenablepatientchoiceandserviceimprovement.Supportforresearchand

innovationisalsoimportantforevidencebasedcommissioningandpracticesothe

reportrecommendsthatcommissioningconsortiashouldhaveadutytopromote

researchandinnovationandtheuseofresearchevidenceintheNHS.

Readthefullreportoftheclinicalandadviceandleadershipgroupatwww.dh.gov.uk/nhsfutureforum

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EducationandTraining

Thisworkstreamwasunusualinthateducationandtrainingwasnotincludedinthe

Bill.

Changes

had

been

proposed

to

the

arrangements

for

education

and

training

commissioningasaconsequenceoftheproposedabolitionofStrategicHealth

Authorities.TheNHSListeningExercisecameontheheelsofathreemonth

consultationontheGovernmentsWhitePaperLiberatingtheNHS:Developingthehealthcareworkforce.Duringthelisteningexercise,andinlinewiththebulkoftheconsultationresponses,

wefoundbroadsupportfortheobjectivesanddesignoftheproposedsystem

alongsideconcerntoensuremaintenanceofhighqualitytrainingresponsiveto

patientsneeds.Patientsneedtohaveconfidencethatservicesandskilled

professionalswillbeavailablewhenandwheretheyareneeded.

Ontheotherhand,whatemergedasoneofthemostwidelyvoicedcriticismsofthe

proposedchangeswasadeeplyfeltconcernattheriskstohealthcareeducationand

traininginEnglandposedbythefastpaceofchange.

EducationandtrainingisthefoundationoftheNHS.Withoutwelltrainedand

motivatedstaffwewillnothavetheelementsnecessaryforaworldclassNHS.

Withoutinvestmentincontinuingprofessionaldevelopmentforallstaff,thecurrent

workforcecannotbeequippedtofacefuturetechnologicalandcaredelivery

developments.Moreover,UKbasedclinicaleducationandtrainingenjoysaworld

classreputationandisavaluablecontributortotheUKeconomy.

Theeffectsofmistakesmadenowintheplanningfortheeducationandtrainingof

healthcareprofessionalswilljeopardisethisandwillhavelongtermeffects. Oneof

ourmainrecommendationsthereforeistotakesufficienttimetoensureanorderly

andsafetransitiontothenewarrangementsforplanningandcommissioning

educationandtraining.

However,twoelementsdoneedtobeaddressedquickly. Werecommendthatthe

proposedHealthEducationEngland,whichhasbeenalmostuniversallywelcomed,

needstobeoperationalassoonaspossibletoprovidefocusandleadershipwhile

therestoftheeducationandtrainingarchitectureisplanned.

Next,whereplansforthenewlocaleducationandtrainingboardscannotbeinplace

bythetimetheSHAsareabolished,theworkforcefunctionsrelatedtoeducational

commissioningandworkforceplanningandthepostgraduatemedicaldeaneries

shouldbetransferredtoahostorganisationuntiltheneworganisationisfunctioning

Wemetconsistentresistancetotransferringtheworkforceplanningfunctionsoutof

theNHSfamilyandsowerecommendfindinganNHShomefortheLocalEducation

andTrainingBoards. Finally,thereneedstobeasubstantialtransitionperiodfor

movingtoalevybasedfundingregime.

Readthefullreportoftheeducationandtraininggroupatwww.dh.gov.uk/nhsfutureforum

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Gettingthepaceofchangeright

ThroughouttheListeningExerciseweheardconcernsaboutthepaceofchange.

Somepeoplefeltthatthechangeswereproceedingtooquickly,withothersconcernedthatthepaceofchangewasnotfastenough.Weneedtostriketheright

balanceandthetransitiontimetableshould,atalltimes,beguidedbythe

philosophythatpatientsmustbetreatedsafely,begiventhehighestqualitycare

possibleandtreatedwithdignityandrespect.Inshort,thepaceofchangeshouldbe

determinedbywhatisinthebestinterestsofqualityandsafetyandthereforethe

bestinterestsofpatients.

TheprincipleofassumedlibertyespousedintheWhitePaperistherightoneand

theGovernmentshouldholdtruetothisvision.Fortheperiodofthetransitionthe

principle

of

earned

autonomy

should

prevail.

Morespecifically,werecommendthat:

theNHSCommissioningBoardshouldbeestablishedassoonaspossibletoensurefocusedleadershipforimprovingqualityandsafetyaswellasmeeting

thefinancialchallengeduringthetransition;

those commissioning consortia that have demonstrated they are ready totakecontrolofbudgetsandthecommissioningprocessshouldbeallowedto

do so fromApril 2013.Where commissioning consortia arenot ready, the

NHS Commissioning Board should commission services on their behalf but

provideallnecessarysupporttoenablethetransferofpowertotakeplaceas

swiftlyaspossible;

allareasshouldhaveshadowhealthandwellbeingboardsassoonaspossibleinorder to support thebuildingof strong local relationshipsand to get to

gripswithunderstanding thehealthandcareneedsof localpopulations to

informemergingjointhealthandwellbeingstrategies;

HealthwatchEngland shouldbeestablishedas soonaspossible inorder toprovidefocussedleadershipforputtingpatientsattheheartoflocalreforms;

changes to the system of education and training must not be rushed.However,HealthEducationEngland shouldbecomeoperationalas soonas

possibletoprovidefocusandleadershipwhiletherestoftheeducationand

training architecture is planned. The roles of the postgraduate medical

Deaneries must be preserved and an interim home within the NHS found

urgently as a consequence of the planned abolition of Strategic Health

Authorities;

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allNHSTrustsshouldcontinuetowork towardsachievingFoundationTrust

statusby2014asauthorisation isaboutclinicaland financial sustainability.

However,2014shouldnotbeanabsolutecutoffdate intheBill.UntilNHS

Foundation Trust governors have been equipped with the right skills and

capability to effectively hold their boards to account, Monitor should

continuetohaveanongoingcompliancerole;

the implementation of Any Qualified Provider should be guided by theprinciples setout in theChoiceMandatewehaveproposedanddrivenby

patients;

Overall,theDepartmentofHealthshouldmoveswiftlytosettingoutanew

transitiontimetabletoprovideclarityforallstaff.

nhs future forum

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