Conservative Health Policy
Kevin Curley, Chief Executive of NAVCA, recently wrote to Andrew Lansley CBE MP with questions about Conservative health policy. The following are the responses to these questions.
Local charities can sometimes run local health and social care services more cost effectively than the public sector. How can we ensure that increased competition does not just drive down price, but also maintains, or improves, quality for service users and encourages innovation?
We believe that competition and choice are the right mechanisms to create a patient-centred and quality-focused NHS. We will encourage any willing provider, including local charities, independent sector organisations and NHS Foundation Trusts, to compete on equal terms for NHS services, as long as they meet the necessary quality standards.
Under our plans, all care will remain free to patients, so they will be making their choices on the basis of the quality of care, rather than the cost of care. Providers will be incentivised to focus on delivering high quality services because our payment system will ensure that money follows the patient to the place that they’ve chosen to receive care.
In a tighter financial climate, cuts in local health and social care services can result in increased pressures on small, local voluntary organisations and community groups that focus on early intervention and prevention. There is evidence of significant reductions in levels of grant funding and NAVCA is concerned that cuts will be more severe as public sector budgets come under greater pressure. Local community based organisations can deliver very cost effective preventative support, which can reduce the need for costly health and social care interventions, such as emergency hospital admissions. How would a Conservative government encourage local authorities and PCTs to continue to invest in effective, evidence-based prevention in the health and social care field?
We know that all too often in the past, budgets earmarked for preventative programmes have been raided to offset short-term pressures created by financial mismanagement. This is counter-productive. We can only hope to meet the big challenges facing the NHS in the form of an ageing and increasing population, expense advances in technology and increasing expectations if we intervene early to tackle the real drivers of demand on the NHS – such as poor diet, lack of exercise and alcohol and drug use.
That’s why a Conservative Government will make public health reform a priority by creating a new structure for public health both locally and nationally. Local directors of public health will be accountable to a jointly appointed public health board, from PCTs and local government together, with the power to allocate independent, ring-fenced budgets to make effective interventions across the health, local government and social housing sectors to promote healthy lifestyles.
I believe that community based organisations will be well placed to win contracts to provide these preventative services, as they have a track record of delivering innovative and cost-effective services that are tailored to the needs of local communities.
Current policy is to open the market up for health services. However, the trend towards larger contracts could push many smaller local third sector organisations out of the market and reduce the number of innovative, community based services that incorporate increased social value. What would you do about this threat?
I have to disagree with the premise of this question. Recently, we have seen the Government renege on their ‘any willing provider’ policy. Andy Burnham has stated that the NHS is the Government’s ‘preferred provider’: third sector and independent organisations will only be awarded contracts as a last resort.
I believe that this is a damaging and retrograde step which will stifle innovation, quality and efficiency improvements. We are determined to do everything that we can to create a level playing field for innovative providers to invest in a rules-based, pro-competitive system, in which providers – irrespective of sector or size – can bid to deliver services without being subject to pointless organisation upheavals, endless bureaucracy or arbitrary political risk.
But we want competition to focus the NHS on the quality of care as much as value: real value for money will not simply mean that the cheapest bid wins. Quality will be assessed by patients exercising choice in consultation with their GPs, who will be responsible for managing their patient’s whole pathway of care with real budgets and bespoke contracts. GPs are well acquainted with the needs of their local population, and will be able to advise patients effectively on different providers’ quality credentials. As I mentioned earlier, I believe that smaller, third sector organisations will be well placed to win these contracts, due to their track record of delivering services that are tailored to local communities’ needs and wishes.
Under Conservative proposals, we understand that most commissioning would be undertaken by GPs or groups of GPs acting on behalf of patients. How would you ensure that GPs have the knowledge, skills and time to commission services and to involve the local third sector appropriately, in contributing both to needs analysis and service delivery? How would practice-based commissioning link to strategic commissioning?
If we are going to drive efficiency and quality improvements on the scale that is necessary it is vital that we bring clinical and resource decision-making together in the commissioning process. We believe that GPs are uniquely placed and equipped to take on this responsibility. GPs are well-paid, senior, public service professionals. Of all NHS staff, they come into the most frequent contact with patients, and are consistently shown to be amongst the most trusted professionals in the country.
In most cases, we would expect commissioning functions to be performed through federations of GP practices operating as consortiums. This would provide a mechanism for groups of GPs to share and better manage this responsibility. We will also require PCTs to establish a contractual formula using the tariff. This would cut down on bureaucracy and enable GP commissioners to focus on securing the best service for their patients. We recognise that there will be some GPs who feel that they do not have the time or expertise to take on this responsibility. In these instances, groups of GPs would be allowed to select another GP consortium, the PCT or a private firm to do the commissioning on their behalf. In most cases, the commissioning role of PCTs should be focused on strategic commissioning and specialised services. Commissioning strategies are currently developed on a regional basis – often resulting in one-size-fits-all solutions. We want to turn this around so that strategic PCT commissioning enables primary care commissioners to fulfill their objectives based on their knowledge of local patient need, rather than dictating to them on the basis of regional strategies.
We believe that there is an important role for third sector providers to play in this commissioning process – both in terms of bidding to provide clinically and cost effective services, and in sharing their expertise on local epidemiology and public health priorities with primary care commissioners.
Many of NAVCA’s members are hosting Local Involvement Networks (LINks) in their local areas. How would Conservative proposals for Health Watch differ from LINks when operating at a local level? Is it envisaged that LINks would be abolished by a Conservative government.
There have been three different mechanisms for patients and members of the public to engage and involve themselves in the development of NHS services in less than four years. We believe that mechanisms for engaging patients in their health services need to endure so that confidence and brand awareness increase over time, and the experience of those who operate these mechanisms is retained. We have therefore committed to avoid unnecessary organisational upheaval and retain LINks as the foundation of our policies for patient and public involvement in health at a local level.
However, we are concerned that LINks in their current setup are too weak and will have too few powers to command the confidence of patients and the public. We will therefore give LINks additional powers of inspection, and the ability to act as advocates for patients who complain about NHS services.
We will also establish a national consumer voice for patients: HealthWatch. HealthWatch will provide support to patients at a national level and leadership to LINks at a local level. It will also incorporate the functions of the Independent Complaints Advisory Body. Health watch will have a clear statutory right to be consulted over guidelines issues nationally concerning the care NHS patient should receive, and over decisions which affect how NHS care is provided in an area.
David Cameron has pledged that improving the health service would be a high priority for an incoming Conservative government. How would you see the local third sector’s role in helping to bring about this improvement?
At present, more than half of NHS staff do not believe that caring for patients is the top priority at their trust. We are determined that this will change. We want to empower patients with increased choice and information so that all providers are incentivised to compete to deliver the most patient-centred services. We believe that by welcoming new voluntary and independent providers through our any willing provider policy, we can increase the number and range of providers offering NHS services, and thereby improve the quality and choice available to patients.
I spend a great deal of time travelling across England visiting different hospitals, GP surgeries and community providers. Time and again, I have come across voluntary providers who are finding gaps in healthcare and preventative provision in their area and are coming up with practical and inventive solutions. We are determined to realise this potential by establishing a pro-competitive framework focused on quality and results to reward these providers, and to give them the confidence to develop and expand their services.
Personalisation is a key policy driver for reforming health and social care services. How would a Conservative government see this agenda developing and what role would you envisage for local third sector organisations?
At every level of the NHS, our goal must be to organise care around the needs and wishes of individual patients. The same must be true in social care. That’s why we oppose Gordon Brown’s plan for a nationalised care service. Where the goal is standardisation, the result will be a reduction in support for informal and flexible structures of care that have been tailored by families and carers to meet individual needs.
Our goal is personalisation of care. So the result we want to see is empowered patients and carers getting involved in the design of their care through direct payments and individual budgets. We know that most elderly people prefer to live independently at home for as long as they possibly can. So our task must be to find flexible ways of empowering and supporting individuals to live at home by looking at telecare, home adaptations and community support schemes that can be tailored to individual needs to preventing them entering residential care or hospital admissions.
Local third sector providers have a great deal of expertise to offer on this count. One such group is the ‘Southwark Circle’ – a community programme linking existing local services together for older people and providing new ones, from help with shopping and basic home maintenance, to meet-up sessions to check on health and happiness. This is a great example of third sector providers taking the lead on the personalisation agenda that I would like to see replicated elsewhere.
