Guide to the NHS Reforms

Issue date

03 Apr 2006

NHS BRIEFING

Against a background of job cuts and deficits, the NHS is experiencing an unprecedented succession of reforms and new policies. This briefing looks at the situation in the health service and suggests ways in which union members can respond to the main reforms, including Commissioning a Patient-led NHS andthe Your Health, Your Care, Your Say White Paper.

Commissioning a Patient-led NHS (CPLNHS)

CPLNHS was published on 28 July 2005 and sets out changes to the way primary care is structured. There will be fewer Strategic Health Authorities (SHAs) and larger Primary Care Trusts (PCTs) through mergers. The new organisations are expected to be in place by around October 2006.

The timetable for reorganisation is as follows:

Jan-March 2006 Consultation on new organisational boundaries

Feb-April 2006 SHA Chief Executives appointed; Shadow SHAs established

April 2006 Shadow new SHAs, PCTs and Ambulance Trusts established

May/June 2006 PCT and Ambulance Chief Executives appointed

July 2006 onwards New SHAs, PCTs and Ambulance Trusts established

Despite the Secretary of State's assertion that there is ' no requirement or timetable' for PCTs to divest their primary care services to the primary, independent or third sectors, the TUC remains concerned that the plans set out in CPLNHS and the White Paper will lead to a large scale programme of divestment and competition. We believe that this programme would lead to the destablisation and fragmentation of primary care services. The TUC is concerned that the reforms have not been tested and will put at risk patient care and staff morale.

How to find the Commissioning a Patient-led NHS website:

http://www.dh.gov.uk

Local consultations on the plans for reconfiguration of PCTs and SHAs ended on 22 March 2006. From 23 March and no later than 30 March, t he employer must inform headquarters of recognised trade unions/staff representatives:

that the consultation is subject to the final decision by Ministers;
that the transfer is going to take place, approximately when, and why
the legal, economic and social implications of the transfer for the affected employees;
whether the employer envisages taking any action in connection with the transfer which will affect employees, and if so, what action is envisaged; and
whether the prospective new employer envisages carrying out any action which will affect the employees, and if so what and within what timescales.

The 90 day formal consultation with staff on transfers must start no later than 31 March (based on TUPE).

Staff working in SHAs, PCTs and ambulance trusts should ask their union reps and managers about the NHS Human Resources Framework and make sure that their NHS organisation is signed up to the principles and actions set out in the framework.

NHS Human Resources Framework

NHS trade unions have worked with the Department of Health and NHS Employers to develop the HR Framework which is aimed at ensuring that the workforce changes arising from implementation of CPLNHS are managed consistently and equitably across England.

The Framework provides guidance for NHS organisations on their obligations to consult with trade unions and individuals. There is also g uidance on transition arrangements, employment issues, action to support staff at risk of compulsory redundancy, pay protection and the potential impact of age legislation on redundancy payments and pension compensation.

How to find the NHS HR Frameworks website:

www.nhsemployers.org/practice/practice-569.cfm

www.nhsemployers.org/practice/practice-605.cfm

Your Health, Your Care, Your Say

The White Paper, which was published on 30 January 2006, aims is to shift the balance between primary and secondary care, with a focus away from hospital-based health care. Accompanied by a 5% shift of resources from hospitals to the community sector, the government hopes to move over one million outpatient appointments from the acute sector into primary care settings.

The TUC welcomes much in the White Paper, especially the commitment to health and wellbeing, improved access to GPs, support for long-term needs and integrated health and social care. However, we are concerned that the White Paper, combined with the proposals in CPLNHS will lead to large scale divestment of primary care services to the private and voluntary sectors, resulting in fragmentation and instability.

What the White Paper means for staff

The White Paper points to wide ranging implications for primary care staff. All PCTs will be required to review the services they both commission and provide and will be encouraged to look for providing services if it is decided they decide that new models are good for patients and supported by staff. This could mean transfer of jobs to private and independent sector providers, the voluntary sector or other not-for-profit organisations.

Other changes for staff could arise through the improved integration between health and social care, with common education frameworks and common career frameworks and rewards. Staff may also be required to develop new competencies to help individuals with health and/or social care needs.

Responding to the White Paper

As there was no Green Paper produced, there has been no formal consultation on the policy. However, there will be opportunities for discussion about the implementation of the policy. For example, the Social Partnership Forum which represents TUC affiliate unions, NHS Employers and the NHS Confederation have set up a working group to discuss the workplace implications of the White Paper. Get in touch with your union representative or branch if you would like more information on this. You should also ask for details of any changes taking place in your organisation. Below are a few questions for which your union could request a formal response.

Questions to ask your employer

Divestment of services to the private or third sectors

What is the evidence base that providing community health services will be more beneficial that direct provision by the PCT?
Will staff be employees of the new organisation?
How long will the contract run for and what will happen if the PCT assesses that services are not being delivered as contracted for?
Will the contract allow the PCT to delay payment (without penalty) because of the NHS financial difficulties?
What is the contract prices? Is this the cost of existing PCT provision of these services?
When the contract comes up for renewal, will the new provider have to compete against other private, voluntary or NHS providers? What will happen to staff if the contract is not renewed?
What will be covered in contracts? Overheads? Maintenance and service contracts? Capital expenditure? Meeting government targets? HR and payroll? Innovations? Professional liability insurance?

Workforce issues

What is the training budget? Will it only cover mandatory and statutory training?
What will happen if the new provider collapses? What will happen to staff?
Will staff have to relocate?
Will the new provider incorporate future NHS pay and conditions agreements and other collective agreements?
Will the new provider commit to Agenda for Change and implement the Knowledge and Skills Framework?
Will staff remain members of the NHS pension scheme?
Will the new provider recognise the trade unions and the appropriate negotiation and consultation procedures?

What can you do if health services are being closed, changed, or treatments are being withdrawn?

Section 11 of the Health and Social Care Act 2001 places a duty on NHS trusts, PCTs and SHAs to make arrangements to involve and consult patients and the public in service planning and operation, and in the development of proposals for changes.

This is a statutory duty, which means consulting and involving:

not just when a major change is proposed, but in ongoing service planning
not just in the consideration of a proposal, but in the development of that proposal; and
in decisions about general service delivery, not just major changes.

How to find the Health and Social Care Act website:

http://www.opsi.gov.uk/ACTS/acts2001/20010015.htm

11. Public involvement and consultation

(1) It is the duty of every body to which this section applies to make arrangements with a view to securing, as respects health services for which it is responsible, that persons to whom those services are being or may be provided are, directly or through representatives, involved in and consulted on:

(a) the planning of the provision of those services

(b) the development and consideration of proposals for changes in the way those services are provided

(2) This section applies to:

(a) health authorities

(b) primary care trusts

(3) For the purposes of this section a body is responsible for health services:

(a) if the body provides or is to provide those services to individuals, or

(b) if another person provides, or is to provide, those services to individuals-

(i) at that body's direction,

(ii) on its behalf, or

(iii) in accordance with an agreement or arrangements made by that body with that other person; and references in this section to the provision of services include references to the provision of services jointly with another person.

Cabinet Office Code of Practice on Consultation

This code is binding on government departments and agencies except in exceptional circumstances

1. Consult widely throughout the process, allowing a minimum of 12 weeks for written consultation at least once during the development of the policy.

2. Be clear about what your proposals are, who may be affected, what questions are being asked and the timescale for responses.

3. Ensure that your consultation is clear, concise and widely accessible.

4. Give feedback regarding the responses received and how the consultation process influenced the policy.

5. Monitor your department's effectiveness at consultation, including through the use of a designated consultation coordinator.

6. Ensure your consultation follows better regulation best practice, including carrying out a Regulatory Impact Assessment if appropriate.

If any of the above criteria have not been followed, this could provide evidence of failure to properly consult. Get in touch with your union branch to look at the proposals and consider whether the consultation could be challenged. You may be able to seek a legal remedy to the failure to consult.

Other changes in the NHS

Payment by Results (PBR) is the new system for the payment of NHS providers, which works by paying healthcare providers a standard national price or tariff for each individual episode of treatment they provide.

Practice Based Commissioning moves the responsibility for commissioning services from PCTs to local GP practices. Budgets are allocated to practices to cover: identifying patient needs; designing health service responsive to those needs; and allocating resources against competing service priorities. Practice based commissioning is introduced to give local clinicians greater control over resources, allowing them to respond better to local and individual needs. It is proposed that there will be 100% coverage of Practice Based Commissioning by the end of 2006.

Patient choice - By 2008 all patients will have a choice of at least four providers of healthcare services, both NHS and private.