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A trio of changes to re-shape the NHS - how will it affect your Trust?
5 June 2009
Over recent months guidance has been issued by the Department of
Health in connection with a number of changes designed to underpin
the values of the NHS and provide clarity as to what can be
expected, not only by those who use it, but by those who work
within it too.
As you may be aware, the Health Bill, currently in draft form,
has been considered by the House of Lords, and has now been
returned to the Commons with final amendments (12 May 2009). The
Health Bill introduces a number of reforms which are intended to
reshape the way services are delivered across the NHS, and which
will impact on all Trusts.
The Constitution
The development of the NHS Constitution was intended to provide
a charter by which patients, staff and taxpayers can identify their
rights and responsibilities in relation to their interaction with
the NHS. The Health Bill places a duty on all NHS organisations to
have regard to the Constitution (which will be reviewed every ten
years) when performing their respective functions.
The Constitution itself summarises the legal duties placed on
all staff working within the NHS in relation to:
- Accountability
- Health and safety
- Confidentiality
- Discrimination
- Express and implied terms of contracts of employment
- Openness and honesty
Trusts must ensure that they are aware of the requirements and
consequences of the terms of the Constitution, and should ensure
that all policies and procedures promote compliance with it, and
can clearly demonstrate the position of the Constitution as being
at the core of its business.
This is, and will remain, a Board responsibility; the
implementation of which must be managed appropriately so as to
avoid it becoming a lawyer’s charter.
Personalised budgets
Additionally, the Health Bill introduces direct payments for
health services (which would take the form of personalised budgets)
with the intention of giving patients greater control over the
health care services they receive. 74 Trusts have expressed their
interest in the pilot programme relating to personalised budgets,
and the Department will be working further with these Trusts in
this regard.
Personal health budgets could take the form of:
- A notional budget held by the commissioner
- A budget managed on the individual's behalf by a third
party
- A cash ("direct") payment to the individual
Of these three, only the direct payment is not currently
available to commissioners as an option (pending the introduction
of the Health Bill), but there is clearly a need for Trusts to
actively consider how best monies can be utilised so as to ensure
the provision of the most appropriate, safe and effective care to
patients, whilst securing value for money and avoiding excessive
administrative costs.
The following principles should underpin any use of personal
health budgets:
- Upholding NHS Values
- Safeguarding and improving quality - safety effectiveness and
experience
- Tackling inequalities and protecting equality
- Ensuring that personal health budgets are purely voluntary and
not coerced by family members or others
- Making decisions as close as possible to the patient
- Working in partnership
Quality accounts
Quality accounts have also been introduced by the Bill, which
would provide information on quality for patients, clinicians and
managers, with the aim of improving local accountability for
services. All Trusts will be required to publish prescribed
information in relation to the following:
- Any NHS services provided by the Trust (including services
provided jointly with other bodies)
- Any services provided by third parties but, which are arranged
by the Trust
- And primary ophthalmic services provided in England, for which
the Trust provides assistance or support
What do these changes mean for Trusts?
Although the Health Bill remains in its draft form, it is some
way through the process of ratification by Parliament. As such,
Trusts should be prepared for the implications of the terms of the
resulting legislation. This process should begin as early as
possible in order to minimise the administrative burden placed on
Trusts.
How can we help?
A review of policies procedures and processes should be
undertaken so as to ensure appropriate systems and measures are in
place to deal with the increased requirements these changes will
bring. We would be pleased to assist you with such a review and the
development of any additional governance arrangements that will be
required.
Our specialist team are experienced in dealing with funding
issues, having worked with PCTs in managing the implications of
direct payments (for social care) and their impact on funding
decisions.
talk to us
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The content of this bulletin is provided for the purposes of
general interest and information. It contains only brief summaries
of aspects of the subject matter and does not provide comprehensive
statements of the law. It does not constitute legal advice and does
not provide a substitute for it.