MPs demand changes to NHS reforms amid calls for greater involvement of healthcare workers

The MPs propose that representatives of nurses, hospital doctors, public health experts and local communities should all be involved as decision-makers alongside GPs in NHS commissioning. They believe it is vital to make these changes to enable the NHS to meet the unprecedented challenge it faces of finding 4% annual efficiency savings over the next four years.

We believe this broadening of the base for commissioning is vital if we are to achieve the changes that are necessary to allow the NHS deliver properly co-ordinated healthcare

In their latest Review of NHS Commissioning, MPs on the cross-party Commons Health Select Committee recommend a number of significant changes to the controversial Health and Social Care Bill, currently before Parliament.

The committee’s chairman, former Health Secretary, Stephen Dorrell MP, said: “We believe it is crucial to get the reform of NHS commissioning right if the service is to confront the massive financial challenge it now faces. Our report contains a set of practical proposals to strengthen the Health and Social Care Bill and make it better able to meet the Government’s objectives.”

“Our proposals are designed to ensure that NHS commissioning involves all stakeholders – GPs, certainly, but also nurses, hospital doctors and representatives of social care and local communities. We believe this broadening of the base for commissioning is vital if we are to achieve the changes that are necessary to allow the NHS deliver properly co-ordinated healthcare”.

The most significant proposals include:

Local Commissioning Boards

Local NHS commissioners are statutory bodies responsible for a large proportion of public expenditure; they should be required to comply with the highest standards of governance and accountability.

In order to satisfy this standard each commissioner should be required to establish a board with membership made up as follows:

GPs should be a majority, but other places should be reserved for:

• A professional social care representative
• An elected member (a councillor or directly-elected mayor) nominated by the local authority
• A nursing representative
• A representative of hospital medicine
• A public health expert nominated by the Director of Public Health

Scrutiny and the patient’s voice

The committee believes that local authority scrutiny of health services should continue and welcomes the extension of local authorities’ health scrutiny powers.

MPs recommend that NHS commissioners should be given a legal obligation to consult with Healthwatch, and that Heathwatch should have a legal obligation to consult with patients and patient representative bodies.

Accountable executives

The committee recommends that all NHS commissioners should have a chief executive and a finance director, both of whom should be members of the board.

Independent chairman

The committee recommends that all NHS commissioners should have an independent chairman appointed by the NHS National Commissioning Board.

Meetings and papers

The committee recommends that the boards of NHS commissioners should be required to meet in public, publish their papers and comply with the rules of the Committee on Standards in Public Life with regard to conflicts of interest among board members.

Accountability to the NHS Commissioning Board

The committee recommends that NHS commissioners should be held to account by the new NHS National Commissioning Board through a clear system of authorisation and assurance.

A new name

The committee concludes that the Government’s plan to call local commissioning bodies ‘GP consortia’ is misleading. It proposes that these bodies should be referred to as ‘NHS Commissioning Authorities’.

Health and wellbeing boards

The committee believes that its own proposals would mean that there is no need to proceed with the establishment of health and wellbeing boards.

Commissioning of primary care

The committee believes that its proposals would mean that there is no need to separate the commissioning of primary and secondary care – as currently proposed in the bill. The committee proposes that NHS commissioning authorities should be responsible for commissioning primary, secondary and community healthcare, as well as for creating robust links with social care.

It is an opportunity to deliver greater efficiency and high quality at the same time. It is a win-win situation. What is the argument against?

Commenting further, Dorrell said: “Ever since 1948 the NHS has suffered from an artificial distinction between primary and secondary care. Instead of entrenching this distinction further, this is an opportunity to abolish it for good and create a single, integrated health service which is able to provide properly co-ordinated health and social care to all patients.

“It is an opportunity to deliver greater efficiency and high quality at the same time. It is a win-win situation. What is the argument against?”