healthcare update - issue seven
Changing the balance of power - Health Act 2009
The relationship between patients and the NHS has changed
dramatically in recent years. Patients are increasingly considered
to be ‘consumers’ of health care, with the right to choose from a
range of providers. The Health Act 2009, which received Royal
Assent on 12 November, goes further to increase choice for patients
and accountability within the NHS. The Act provides for direct
payments to patients, ‘quality accounts’ and new duties to comply
with the new NHS Constitution.
Direct payments
The Health Act allows Primary Care Trusts (PCTs) to make direct
payments to patients for their treatment through personal health
budgets. If payments are not directly ‘cash-in-hand’, patients may
have their budget held by a third party, and will be able to use
the money to buy health care from a variety of providers, including
from the voluntary and private sectors.
Direct payments are already available to pay for social care.
The Health Act gives patients a similar power to manage their own
health care, including treatment, physiotherapy, home nursing and
care managers. Direct payments are likely to be most suitable for
people with long-term conditions such as diabetes or asthma, and
users of mental health services. The government is also expected to
consider extending the payments to cover maternity services.
The scheme will be voluntary and will not cover NHS emergency
services. Patients who opt to receive direct payments are likely to
approach buying their care increasingly as ‘consumers’ and will
expect a high level of service from the treatments they pay
for.
From Summer 2010, direct payments for health care will be
piloted across the country, and will surely change the nature of
the relationship between a patient and the NHS, and will have
implications in terms of planning the flow of patients and the
income streams of NHS bodies as the funding follows the
patients.
NHS Constitution
The NHS Constitution, which was launched in January 2009
following Lord Darzi’s review of the NHS, High Quality Care for
All, focused on patient experience. The Health Act places a duty on
NHS bodies to adhere to the principles of the Constitution, though
in effect the NHS already has an obligation to comply with it
because it is guidance from the Department of Health.
When it was published, it was said that the Constitution does
not create new rights, but simply pulls together existing rights in
one place. The Constitution was to be reviewed every ten years, and
the detailed handbook every three years. However, a consultation
has already been published on 10 November 2009 which proposes to
add new rights to the Constitution, including:
- Introducing statutory waiting times for treatment
- Allowing patients to switch to a private provider if they have
waited longer than 18 weeks to see a specialist following referral
by a GP
- A right for cancer patients to receive funding for private
treatment if they have not seen an NHS specialist within two weeks
of GP referral
There seems therefore to be a drive towards transforming
government targets into patients’ rights.
The consultation is open until 5 February 2010 and will be
considered in more detail in our next newsletter. To read the full
consultation in the meantime,
click here to link through to the Department of Health
website.
Quality accounts
The Health Act requires NHS Trusts to produce quality accounts
with similar standing to the financial accounts. Quality accounts
will provide information about the performance of trusts, enabling
patients to make informed choices about their care. As an example,
the accounts will include data on adverse incidents, complaints and
the MRSA rate. They will also reflect the subjective patient
experience from in-patient surveys.
Quality and patient experience are paramount in the new
relationship between patients and the NHS. Providers must now
respond to patients and provide health care in a radically
different way.
As if this is not enough to deal with, the way in which the NHS
is regulated is also changing, with the requirement for all NHS
providers to be registered with the Care Quality Commission (CQC)
from April 2010. The CQC recently published interim
guidance on the registration requirements, and will publish the
final guidance in December.
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The content of this update 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.