The Rt Hon Andrew Lansley MP, Secretary of State for Health

EQUITY AND EXCELLENCE: LIBERATING THE NHS
Secretary of State for Health Andrew Lansley in July 2010 set out the government's ambitious plans to reform the NHS during this Parliament and for the long term.

The White Paper ‘Equity and Excellence: Liberating the NHS’ detailed how power will be devolved from Whitehall to patients and professionals.

• Professionals will be free to focus on improving health outcomes so that these are amongst the best in the world. Improving the quality of care will become the main purpose of the NHS.

• Patients will get more choice and control, backed by an information revolution, so that services are more responsive to patients and designed around them, rather than patients having to fit around services. The principle will be ‘no decisions about me without me’.

• Under the plans, patients will be able to choose with which GP practice they register, regardless of where they live, and choose between consultant-led teams. More comprehensive and transparent information, such as patients’ own ratings, will help them make these choices together with healthcare professionals.

• Groups of GPs will be given freedom and responsibility for commissioning care for their local communities. Providers of services will have new freedoms, and they will be more accountable. There will be greater competition in the NHS and greater co-operation. Services will be more joined up, supported by a new role for local authorities to support integration across health and social care.

• As a result of the changes, the NHS will be streamlined with fewer layers of bureaucracy. Strategic health authorities and primary care trusts will be phased out. Management costs will be reduced so that as much resource as possible supports frontline services. The reforms build on changes started under the previous government.

Liberating the NHS: legislative framework and next steps
Following the publication of the White Paper ‘Equity and Excellence: Liberating the NHS’, the government has undertaken an extensive process of consultation and engagement around the White Paper proposals. To ensure that as wide an audience as possible was involved, summaries of the White Paper and related consultation documents were made available in various accessible formats, including easy-read, alternative language, large print and Braille. A presentation summarising the proposals and the consultation questions and a guide to running a consultation event were also produced for larger organisations to use when engaging with their members.

Strategic Health Authorities (SHAs) held a number of engagement events across the country targeted at regional NHS and local authority staff. The Department of Health also organised nationwide consultation events in collaboration with Regional Voices (a strategic partner of the Department of Health which co-ordinates nine regional networks of voluntary- and community-sector bodies). These events were targeted at patient representative groups, the voluntary sector and community organisations.

A variety of other discussion and engagement events were held, with groups including the department’s Social Partnership Forum, the National Stakeholder Forum, the Third Sector and Social Enterprise Sounding Board, local authority chief executives and councillors, and strategic partners. A core principle of the White Paper is the need to eliminate discrimination and reduce inequalities in care; and the department also held discussions about equality and diversity with members of the NHS Equality and Diversity Council and other key partners.
More than 6,000 responses were received on the White Paper and the related consultations. The number of respondents was less, as some people submitted separate contributions to the different consultations, while others sent a single consolidated response. A full list of organisations that responded is available on the Department of Health’s website.
Responses were received from a very wide spectrum of individuals and organisations, including: patients and members of the public, clinicians, voluntary organisations, patient representative groups, local authorities, Local Involvement Networks (LINKs), NHS organisations and staff, independent providers, pharmacists, academics, professional bodies and Royal Colleges, think tanks and trade unions.

How the government has modified its original proposals
The government expressed its gratitude to everyone who contributed to the consultations. The richness and diversity of consultation responses provided a valuable perspective on how the White Paper was received locally, highlighting the areas where there was most enthusiasm as well as the issues that raised greatest concern.

Responses contained a broad mix of support, suggestions for improvement and critical challenge, which helped develop the proposals and translate them into legislative provisions in the Bill. In particular, the government decided to:
 
• Allow a longer and more phased transition period for completing the reforms to providers: for example, retaining some of Monitor’s current controls over some foundation trusts while the new system of economic regulation is introduced
• Significantly strengthen the role of health and well-being boards in local authorities and enhance joint-working arrangements through a new responsibility to develop a ‘joint health and well-being strategy’ spanning the NHS, social care, public health and, potentially, other local services. Local authority and NHS commissioners will be required to have regard to this
• Create a clearer, more phased approach to the introduction of GP commissioning by setting up a programme of GP consortia pathfinders. This will allow those groups of GP practices that are ready to start exploring the issues and will enable learning to be spread more rapidly
• Accelerate the introduction of health and well-being boards through a new programme of early implementers
• Create a more distinct identity for HealthWatch England led by a statutory committee within the Care Quality Commission (CQC)
• Increase transparency in commissioning by requiring all GP consortia to have a published constitution
• Change the proposal that maternity services should be commissioned by the NHS Commissioning Board. This reflects the weight of consultation responses, arguing that in order to focus on local needs, maternity services should be the responsibility of GP consortia backed by national support to secure improvements in quality and choice

• Recognise that the original proposal to merge local authorities’ scrutiny functions into the health and well-being board was flawed. Instead, councils’ formal scrutiny powers will be extended to cover all NHS-funded services and will give local authorities greater freedom in how these are exercised

• Phase the timetable for giving local authorities responsibility for commissioning NHS complaints advocacy services and allow flexibility to commission from other organisations as well as from local HealthWatch

• Give GP consortia a stronger role in supporting the NHS Commissioning Board to drive up quality in primary care

• Create an explicit duty, for the first time, for all arms-length bodies to co-operate in carrying out their functions, backed by a new mechanism for resolving disputes without the secretary of state having to act as arbiter. In particular, Monitor and the NHS Commissioning Board will have to work jointly in setting prices rather than have Monitor decide and the board able to appeal.

The full document ‘Liberating the NHS: Legislative Framework and Next Steps’ can be seen on the Department of Health’s website and sets out the government's response to the consultation on the implementation of the White Paper ‘Equity and Excellence: Liberating the NHS’ and its accompanying consultation documents — ‘Increasing Democratic Legitimacy in Health’; ‘Commissioning for Patients’; ‘Regulating Healthcare Providers’.

It describes how the government has developed its plans in the light of consultation and gives further detail on the NHS reforms and a timetable for implementation. The document also explains how the consultation has shaped the Health and Social Care Bill, planned for introduction in January 2012, reaffirming the government’s commitment to reforming the NHS.

Government launches NHS ‘listening exercise’
In April 2011, the government launched a two-month ‘listening exercise’ to hear the public’s views on NHS modernisation. The listening exercise was launched by Prime Minister David Cameron, Deputy Prime Minister Nick Clegg and Health Secretary Andrew Lansley.

Mr Cameron said he passionately believed in the NHS but said “maintaining the status quo was not an option” if it was to cope with the demands of a rapidly ageing population. The PM said the exercise, which saw events running across the country, was a chance to “pause, listen, reflect and improve on our proposals and was a genuine chance to make a difference”.

The engagement exercise focussed on four key areas:
• The role of choice and competition for improving quality
• How to ensure public accountability and patient involvement in the new system
• How new arrangements for education and training can support the modernisation process
• How advice from across a range of healthcare professions can improve patient care.

The Department of Health also published a leaflet, ‘Working Together for a Stronger NHS’, setting out why changes are needed in the NHS.

Alongside the public listening exercise, a new group of patient representatives, doctors and nurses were brought together to listen and report back to government.

Chaired by Birmingham GP and former Royal College of General Practitioners Chairman Steve Field, the new ‘NHS Future Forum’ will provide a valuable channel for the thoughts and opinions of patients and staff on the ground.

Outcome of the listening exercise
Following the NHS listening exercise on 14 June 2011, Prime Minister David Cameron delivered a speech in response.

“Ten weeks ago we pressed pause on our NHS reforms.

We wanted to speak to professionals, patients and everyone who cares about the NHS … and make sure our proposals were absolutely right. Now there were those who said this was a humiliating U-turn, that we were back-tracking and ditching all our plans. And there were those who said the opposite … that actually we weren’t going to change anything — that this was all a big PR stunt.

Today we show that both are wrong.

The fundamentals of our plans … more control to patients, more power to doctors and nurses, less bureaucracy in the NHS … they are as strong today as they’ve ever been.

But the shape of our plans … the detail of how we’re going to make all this work … that really has changed as a direct result of this consultation.
We listened to what professionals and patients told us.

• You wanted us to make clear that competition isn’t there for its own sake but to make life better for patients — done

• You wanted us to get specialists (not just GPs) on commissioning groups — done

• You wanted us to join up the different parts of the NHS, to put integration right at the heart of our reforms — done.

We have listened, we have learned, and we are improving our plans for the NHS. We come here today with a substantive package of changes … and for that I want to thank Steve Field, the Future Forum and everyone who took part. I want to remind people why we’re doing this, because behind all the talk about processes and policies there are people saying ‘what’s the point of these plans?’ ‘what do they actually mean for me?’.

Today I want to answer that. I want to set out the five big things these reforms mean for you.

Free Health Service
One, they mean the NHS you know and love is safeguarded and secured for the years ahead.

We all know about the pressures on our health service. A population ageing so fast that the number of people over 85 is set to double over the next two decades; new drugs and treatments that are so expensive they add hundreds of millions to the bill each year.

This is a monumental challenge for the NHS. Fail to reform now and we could see a bigger and bigger black hole opening up in the budget. Fail to confront this and the founding principle of the NHS — health care available to everyone who needs it, free at the point of use — would be in danger.

I refuse to let that happen.

Because of what we’re doing today, the NHS will continue to thrive tomorrow … it will continue to be free at the point of use, based on need and not ability to pay … and our children and grandchildren will be able to rely on it — just as we have done.

Choice
The second thing these reforms mean for you is greater choice … the choice to get treated where you want, the way you want.

So, if you’re being treated for cancer and you want to have your drug treatment at home at a time that suits you, you should have that choice.
If your child needs a wheelchair and you want to choose the supplier, you should that choice. If you’ve got problems with your heart and need regular tests, you should be able to decide when and where.

This is your National Health Service, and we are going to put you in the driving seat.

Access to the best
Three, they mean you’re going to have access to the best, because, as well as giving you more choice, we’re giving you more information — information on how hospitals are performing, on survival rates from operations, on patient satisfaction … all there online for you to see.

In this non-bureaucratic, patient-driven, clinician-led, open and transparent system … you’re going to be able to seek out the best treatments there are.

Of course, what’s important to people isn’t just how and where they get treated but when they get treated. That’s why waiting times are online too. We are keeping the 18-week limit — and we will keep on measuring how long people have to wait in A&E.

Be in no doubt that this government is pledged, determined, committed to keeping waiting times low.

Breaking down barriers
Four, these reforms will mean a smoother, more seamless journey through the health service.

If there’s one big frustration a lot of people have, it’s that the NHS can seem a bit disjointed. You see different doctors at different appointments, all to talk about the same thing. Or your mother gets stuck in hospital when she wants to come home, because social services and the NHS aren’t properly joined up.

Our plans are about breaking down these barriers … with specialists from across the NHS talking to each other to get the best for you. And we’ll be exploring ways to bring the different pots of money together across health and social care.

This might sound dry — but it’s going to make a real difference to people’s lives.

Long-term conditions
And five, these reforms will mean a big improvement in the way people with long-term conditions are treated.

Today, one in three people have a condition like asthma, arthritis or diabetes. They account for 70 per cent of spending on health. They are the biggest users of the NHS … but frankly, the NHS hasn’t caught up.

People routinely end up in hospital when their condition could have been managed at home. Patients have to check in with specialists when they’d quite happily monitor themselves.

These reforms change all that. Putting spending power into the hands of doctors and nurses is going to make a radical difference to millions of lives. Why? Because, together with your GP, you’ll be able to design a package of care that fits into your life.

So say you’ve got diabetes. With our changes, as part of your care planning, you can talk to your GP about access to education and support so you can manage your own blood sugar levels … …something we know works, and which will help you reduce your chances of winding up in hospital to be stabilised when it gets too late. That’s good for you — giving you more independence and more control.

And it’s good for our NHS — as we start to manage these long-term conditions much more effectively and efficiently.

Conclusion
So this is what we’re doing this for:

• Putting power in patients’ hands
• Making sure everyone has access to the best
• Making the whole system more seamless
• Treating long-term conditions the right way, not the old way
• Above all, safeguarding our NHS and everything it stands for.

Ten weeks ago, we paused our legislation. Today, we show how we are improving it.

Ten weeks ago, some of the people who worked in our NHS were sceptical of our changes. Today, we are taking people with us.

It’s in this spirit of unity that we want to continue. We’re going to carry on listening, and we’re going to carry on working together — for the good of our NHS.”

Biography of the Rt Hon Andrew Lansley CBE, MP, Secretary of State for Health
Mr Lansley was educated at Brentwood School, Essex, and the University of Exeter, where he was President of the Guild for Students. He began his own career as a civil servant, working at the Department of Trade and Industry.

In 1992, Mr Lansley was awarded a CBE for running the Conservative campaign for the 1992 General Election. In 1997, he was elected MP for South Cambridgeshire and joined the Shadow Cabinet as Health Secretary in 2003.