Health secretary Andrew Lansley has announced that primary care trusts are to be abolished as part of a massive reorganisation of the NHS that will start with the Department of Health taking more control of its finances to ensure a measure of stability.
At a press briefing to launch his white paper – ‘Equity and excellence: liberating the NHS’ – Lansley said the coalition government had initially expected PCTs to have a ‘residual role’ but it became clear they had no future as its plans were firmed up.
GPs will be given responsibility for commissioning most NHS services, working either for the patients of their own practices or for wider populations as part of commissioning consortia.
Responsibility for commissioning specialist and tertiary services will pass to a new NHS Commissioning Board; which has accrued more and more powers as the government’s plans have emerged.
The board will also be responsible for commissioning dentistry and primary medical services (or the services that GPs themselves provide), for setting the NHS tariff and a wide range of standards, and for intervening in ‘failing’ commissioning boards and provider trusts.
PCTs’ public health and health promotion responsibilities will pass to local authorities, who will also be given new roles in scrutinising the NHS and for commissioning new Health Watch services that will operate on a similar model to the Community Health Councils abolished by Labour.
The white paper says a new, national Health Watch will operate as “an independent consumer champion” from within the Care Quality Commission, which survives as a quality inspectorate.
Other quangos with an apparently assured future include Monitor, which is destined to become a market regulator; NICE, which will develop quality standards to replace targets for the NHS and social care; and the Information Centre, which is billed as having ‘lead responsibility’ for collecting data to give patients more choice over their treatment and care.
The DH will eventually be slimmed down to become a Department of Public Health, while strategic health authorities will be "phased out" and trusts will be expected to become both foundation trusts and social enterprises.
However, at the press briefing, NHS chief executive Sir David Nicholson, said it might be necessary for the DH and SHAs to take more control in the short term. “There is a very clear and coherent vision of the future of the NHS,” he said.
“The big issue is how we get from here to there. In the short term, we may need to take more control nationally and regionally of the money in order to decentralise later.”
Much of the detail of the white paper will be fleshed out in strategies and documents that will be issued over the coming months.
However, in response to a question on the future of the National Programme for IT in the NHS, Sir David said: “In the next four weeks we will be making an announcement on the NPfIT and how we will reconfigure and change it to reflect the bottom-up changes in this document [Liberating the NHS].”
The white paper says there will also be an information strategy setting out how the government will make good on the Conservatives’ manifesto promise to deliver an “information revolution” to patients.
“Our vision is patient centered-something we’ve called “no decision about me, without me,” Lansley told the House of Commons as he presented the white paper to MPs.
“With patients empowered to share in decisions about their care, with professionals free to tailor services around their patients, and with a relentless focus on continuously improving results I am confident that we can deliver the efficiency and the improvement in quality that is required to make the NHS a truly world class service.”
However, former health secretary and Labour party leadership contender Andy Burnham said the proposals were “a roll of the dice, a giant political experiment with no pilots and no evidence. It turns order into chaos.”