NHS White Paper – Equity and Excellence: Liberating the NHS

The NHS is changing dramatically – we take a look at how it will be transformed, how some of its functions will shift to local authorities, and the implications for accident prevention and partnership working.

Liberating the NHS – what is changing?

Equity and Excellence: Liberating the NHS strongly reflects the coalition government’s ambition to initiate and implement rapid health service reform to realise two main outcomes:

• a more simplified and accountable health structure
• greater financial and practical efficiencies within national health services.

This process will begin immediately through a consultation process “with clinicians, patients, carers and representative groups”.

Read more about the consultation, and have your say: Increasing democratic legitimacy in health

The two outcomes will be achieved through the policy proposals below.

Local authorities will take on the function of joining up the commissioning of local NHS services, social care and health improvement, via health and wellbeing boards. They will:

• Lead on local health improvement and prevention activity.
• Promote integration and partnership working between the NHS, social care, public health and other local services and strategies.
• Lead joint strategic needs assessments and promote collaboration on local commissioning plans.
• Build partnerships for service changes and priorities.

Local Directors of Public Health, jointly employed by the local authority and the new Public Health Service, will control the ring-fenced public health budget. The public health budget will be allocated to reflect relative population health need, with a new health premium to promote action to improve population-wide health and reduce health inequalities.

The NHS Commissioning Board will have five main functions:

• Providing national leadership on commissioning for quality improvement.
• Promoting and extending public and patient involvement and choice.
• Ensuring the development of GP commissioning consortia.
• Commissioning services that cannot be solely commissioned by GP consortia, such as dentistry, maternity services, family health services etc.
• Allocating and accounting for NHS resources.

How will the reforms save money?

The White Paper reflects the government’s determination to tackle the budget deficit and growing debt across all departments, including health where they see savings to be made in new NHS structures and through efficiency gains.

The emphasis is primarily on front-line NHS services rather than preventative issues, as efficiency gains, projected at reaching £20 billion by 2014, “will be reinvested to support improvements in quality and outcomes” and a 45% reduction in NHS management costs will be used to free up “further resources for front-line care.”

However, the consultation on health and wellbeing boards proposes that they will play a lead role in determining the allocation and strategy for place-based budgets on cross-cutting health issues that require effective partnerships. Place-based budgeting (formerly known as Total Place) focuses on how a whole area approach to public services can lead to better services at lower cost – a way of “achieving more with less”. The Total Place pilots looked at how prevention and early intervention could deliver savings downstream.

Opportunities for child accident prevention

The NHS White Paper sets out the government’s aims to change the way that the health service is managed and to move responsibility for local health improvement to local authorities. CAPT’s Chief Executive, Katrina Phillips, outlines the implications for accident prevention partners.

Are the changes looking positive for accident prevention partners?

There are a number of opportunities for child accident prevention in the NHS White Paper:

First, a renewed focus on public health could provide a real boost for work on child accident prevention. In the past, concerns have been voiced that the NHS is primarily an “illness service” rather than a “health service”. The creation of a new national Public Health Service could help to redress this imbalance.

A ring-fenced public health budget from April 2012 could stop funds for preventative work being raided to treat preventable illness and injury. There may be opportunities for funding for child accident prevention from the public health budget, especially if the case for saving money through accident prevention can be made effectively. Given the stark inequalities in childhood accidents, a new health premium designed to promote local action to reduce health inequalities is also to be welcomed.

In addition, the use of place-based budgets by local health and wellbeing boards could facilitate an investment in prevention and early intervention, as localities identify the considerable savings that can be made by tackling the causes rather than treating the symptoms.

There is also much to be welcomed in the emphasis on partnership working, integration and collaboration across local services and strategies, including using joint commissioning and pooled budgets to deliver services joined up around the needs of children and their families.

Many of you already see the benefits of partnership working for child accident prevention. Some areas already have posts jointly funded by the local authority and PCT. The proposals may offer greater opportunities to form and build on partnerships that help prevent serious childhood accidents.

What are the other implications?

Of course, while there are opportunities, there are also still huge uncertainties:

Will child accident prevention be seen as part of public health and the local health improvement agenda? It’s not yet clear that accident prevention is fully understood by the Department of Health as part of public health. The focus to date has been on obesity, smoking, drinking and lack of exercise. Little has been said about stopping healthy children being killed or seriously injured in preventable accidents. And there has been little recognition of the huge financial costs of childhood accidents to the NHS – over £131 million spent on emergency hospital admissions alone.

Where do children and young people feature? Concerns have been raised in the past that the needs of children have been sidelined in the NHS. Will this carry over into the new Public Health Service and the work of local health and wellbeing boards? The Association of Directors of Children’s Services has suggested that health and wellbeing boards should have a specific duty to consider the health needs of children.

At what level will the new ring-fenced public health budget be set? Will there be expectations that it will have to compensate for cuts made elsewhere in local authorities – for example, the 40% cuts in local road safety budgets? Vitally, what will happen to NHS and local authority budgets for preventative work during the transitional period? Will they be seen as soft targets and fall victim to “efficiency savings”?

How will the transition process be managed? How will links be forged between, for instance, Directors of Public Health and Directors of Children’s Services over preventative services for children? What will the relationship be between local health and wellbeing boards and Children’s Trusts? How will Local Safeguarding Children Boards and Child Death Overview Panels work with health and wellbeing boards? Importantly, how will organisations be supported during the transitional period, so that they can make the most of the opportunities that are to come?

Finally, how will those with accident prevention expertise fare during the transitional period? Will local authorities and PCTs have their eye on the longer-term? Or will the need to deliver savings now prompt a much more short-term view, resulting in a loss of knowledge and expertise? Is there a risk that the need to make short-term cuts will jeopardise longer-term proposals?

Do tell us what you think about the pros and cons of the proposals. We’re also keen to understand how the Making the Link project can best support you and your organisation during this time of change. Either join in the discussion on the forum or email Katrina Phillips.

How can accident prevention partners drive the issue forward?

Some of this may become clearer when the Public Health White Paper is published in December. However, it is vital to start to make the case for child accident prevention now, as much of the detail is yet to be developed.

The stated ambition of “broad consultation – with local government, patients and the public, as well as external organisations” means that the case for accident prevention as a money-saving and life-saving activity can be widely made over the coming months.

There are a number of things that accident prevention partners and practitioners (and all those who read Making the Link) can do to ensure that child accident prevention is seen as a priority within the new public health service.

• Can you make the case for child accident prevention as an important part of local health improvement work – and an issue that can really benefit from an integrated, partnership approach – within your organisation’s response to the consultation on the NHS White Paper?
• Will you have opportunities to discuss child accident prevention within your professional bodies and inform their responses to the consultation?
• Can you continue to embed child accident prevention within your local strategic planning and your health improvement and prevention activities, so as to give it the best chance of surviving this transitional period?

While CAPT will obviously be championing the cause of children and young people, and the benefits of a partnership approach to accident prevention, we need you to add your voice to ours. There are real opportunities to improve the health and wellbeing of children, especially the most disadvantaged, and to secure considerable cost savings. But we need your support to turn these opportunities into realities.