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The House of Commons Health Select Committee report highlights what appears to be a widespread view that there is a need for more thought to be given to how the government's aspirations for future health service delivery would be achieved in practice, says Beachcroft LLP.
Stephen Hocking, a partner at the firm, and one of the witnesses called to give evidence to the Health Select Committee on 1 March, commented:
"The Committee has reached the same conclusion as many other commentators on the Bill - that it was all about ideas and that not enough thought had been given as to exactly how the government's aims would be achieved in practice. The Committee's proposals seek to redress that balance and work through the practicalities in more detail, removing extraneous proposals and adding pragmatic safeguards.
"The proposals acknowledge many of the concerns expressed about GPs' ability to meet their proposed new responsibilities, and the doubts raised as to how Health and Wellbeing Boards (HWBs) were to achieve real integration on the ground, without being able to wield any carrots or sticks in terms of commissioning power.
"However the Committee's proposals do not cure all ills, and they raise their own questions. In particular, there will be doubts as to how effective integration between health and social care will be if there is no single body responsible for strategy on integration and if local authorities are required to work with - and provide members for - multiple Commissioning Authorities rather than "hosting" the integration work themselves."
During the inquiry Stephen Hocking expressed doubt about whether the Secretary of State would in practice be able to leave issues connected with the day-to-day operation of the NHS to the NHS Commissioning Board and consortia. In comments which are quoted in the Committee's report he said:
"Whatever the Bill has to say, I have no doubt that [voters] will continue to think that the Secretary of State for Health, or the Government of the day or Parliament generally - whatever it may be -is accountable for the way the taxpayers' funds are spent in the Health Service. Perhaps that is no bad thing." The House of Commons Health Committee report examines the provisions of the Health and Social Care Bill 2011 which relate to commissioning. The report provides another indicator that the Bill is due for a stormy passage through Parliament. Stephen Hocking added:
"The Committee does not, for the most part, take issue with the underlying aims and philosophy of the Bill - but it states the clear opinion that in its current form the Bill will not be effective in achieving its aims. In particular the Committee wants the Bill to move away from its core reliance on GP consortia for commissioning of services. The Committee does not disagree with importance of local commissioning or with the need for GPs to play a central in that commissioning. It is concerned about the structure of local commissioning as set out in the Bill, in particular the extent of its reliance on GPs without direct reference to other stakeholder interests and the lack of prescribed governance and accountability safeguards. The Committee is concerned that GP consortia will not have sufficiently strong governance and accountability with regard to the amount of public money that they will be spending."
In place of GP commissioning consortia the Committee proposes the establishment of local commissioning bodies, to be called "NHS Commissioning Authorities". The membership of these bodies would be made up with a majority of GPs, but would also include local authority representatives (including the Director of Public Health, a social care professional and an elected member) and representatives of other clinical perspectives including secondary care clinicians and nurses.
These bodies would be subject to clear requirements as to governance, which would be set out in secondary legislation and would put them on a par with other public bodies in terms of public accountability. In light of this proposal, the Committee would then drop the proposal for statutory local authority Health and Wellbeing Boards (HWBs). The NHS Commissioning Authorities would instead provide the forum in which local authority and NHS perspectives would be brought together. The HWB responsibilities regarding preparation of local strategy for health and social care provision and promotion of integration in health and social care delivery would be "shared" jointly amongst the NHS Commissioning Authorities, local authorities and the new Public Health England.