3 Applying the lessons to the new NHS
17. In July 2010, the Secretary of State for Health
published Equity and excellence: liberating the NHS, a
White Paper setting out the Government's long-term proposals for
the future of the NHS. The Department told us that the proposed
new arrangements, together with a public health white paper, due
for publication in autumn 2010, should provide an opportunity
to narrow health inequalities.[28]
18. The Department told the Committee that under
its proposals its new role would be to improve public health,
tackle health inequalities, and reform adult social care. A new
Public Health Service would be created to integrate and streamline
existing health improvement and protection bodies. For all other
healthcare, the Department would establish an NHS Commissioning
Board, responsible for achieving health outcomes, allocating resources,
improving quality improvement, and promoting patient involvement
and choice. The Department told us that this Board would have
an explicit duty to promote equality and access and would be held
to account through an outcomes framework.[29]
19. The Government intends to devolve power and responsibility
for commissioning healthcare services to GPs and their practice
teams working in consortia.[30]
We expressed concern as to how these arrangements would encourage
GPs to work in deprived areas, especially given the Department's
lack of success to date. The Department told us that responsibility
for commissioning primary care would reside with the Commissioning
Board, which would be responsible for the appropriate distribution
of GP practices around the country.[31]
20. The White Paper also proposed the abolition of
primary care trusts by 2013, with their responsibilities for local
health improvement transferred to local authorities, who would
jointly employ a Director of Public Health with the Public Health
Service. The Department told us that its intention was for each
local authority to establish a Health and Wellbeing Board that
would scrutinise what the NHS and the Public Health Service were
doing to reduce health inequalities.[32]
21. The Department said that the Health and Wellbeing
Boards would have the power to hold local commissioners to account
for what they delivered.[33]
The Committee was not convinced about the effectiveness of the
proposed accountability arrangements for GPs and GP consortia,[34]
and was concerned that local Health and Wellbeing Boards would
have no control over their funding. The Department told us that
Health and Wellbeing Boards would be able to make their concerns
clear to consortia, and talk to them about changes they needed
to make, while placing these concerns in the public arena to enable
debate.[35]
22. The Department told us that action for improving
population-wide health and reducing health inequalities would
be funded from a ring-fenced public health budget. The Secretary
of State, through the Public Health Service, would set local authorities
objectives for improving their health outcomes.[36]
Approximately four per cent of total health expenditure in England
was estimated to be spent on prevention and public health, but
spending on prevention and public health varied between local
areas.[37] The Department
was unable to say whether the current level of public health spending
would at least be maintained.[38]
2 28 7 Qq 98-99, 116 Back
2 29 8
Q 99 Back
2 30 9
Q 99 Back
3 31 0
Qq 100-101 Back
3 32 1
Q 99 Back
3 33 2
Qq 106-115 Back
3 34 3
Qq 106-114, 125-128 Back
3 35 4
Qq 113-115 Back
3 36 5
Qq 99 and 116-120 Back
3 37 6
Q 106; C&AG's Report, para 4.18 Back
3 38 7
Qq 117-119 Back
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