An overview of recent
NHS reform in England
April 2013
Review date: October 2013
Introduction
This presentation provides a synopsis of the main
changes brought about by the Health and Social Care
Act 2012 and contained in the draft Care and Support
Bill. These apply to England only.
It is designed to help RCN members understand the
reforms and how they will affect patients and nursing
practice.
Contents
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History of the reforms.
 Changes brought about by the Health and
Social Care Act 2012, including:
 changes to commissioning
 changes affecting providers
 the changing role of Monitor.
 The draft Care and Support Bill 2012.
 What the RCN is doing on behalf of members.
History of the changes
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NHS White Paper published in July 2010
Health and Social Care Bill published in
January 2011
The Bill was passed and became the
Health and Social Care Act in March 2012
Draft Care and Support Bill 2012 currently
going through Parliament (as of April
2013)
The Government’s aims for the
Health and Social Care Act
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A stronger voice for patients:
 Patient-centred care – “No decision about me without me”
 Creation of Healthwatch England within the CQC and Local
Healthwatch organisations to represent the voice of service
users
Focus on patient outcomes rather than processes
Extend choice and competition
Overhaul of the commissioning structure
Increase autonomy of providers with all NHS trusts becoming
foundation trusts (FTs)
New approach to provider regulation – creation of a licence
issued by Monitor
The RCN and the Health and Social Care Bill
The RCN welcomed:
The RCN was concerned by:
The focus on improving patient
outcomes
No introduction of mandatory nurse
staffing levels to act as a safeguard
Increasing patient choice
Reforms acting as a distraction from
the “Nicholson Challenge” to save
£20bn from the NHS budget by
2015
Reducing inefficiency
High cost of implementation
Increased complexity of the new
structures with barriers to cooperation
Increased competition could lead to
fragmentation of services and
integrated care provision
The RCN and the Health and Social Care Bill
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Because of these concerns, the RCN moved to
oppose the Bill in January 2012.
As the Act has now passed, the RCN is committed to
help make the reforms work for the benefit of patients
and our members.
What is commissioning?
Commissioning is the process through which NHS
health care services are “purchased” on the behalf of
service users. It is a continuous cycle made up of:
 strategically assessing population needs
 prioritisation
 procuring services from providers
 monitoring the performance of providers.
Changes to the commissioning
system – from April 2013
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Abolition of primary care trusts (PCTs) and strategic health
authorities (SHAs)
NHS England (previously known as the NHS Commissioning Board)
established – provides leadership for the NHS in England and
commissions primary and specialist care. Has regional and local offices
throughout the country.
Clinical commissioning groups (CCGs) commission the majority of
local health services
Transfer of public health from the NHS to local authorities, with a new
body - Public Health England - taking a national leadership role.
Creation of Health and Wellbeing Boards at local level, bringing
together people from commissioning, health care, social care and
public health to develop Joint Strategic Needs Assessments and Joint
Health and Wellbeing Strategies.
Healthwatch – the independent ‘consumer champion’, replacing the
patient representative bodies Local Involvement Networks (LINks)
How do they fit together?
Department of Health
NHS England
Health and
Wellbeing
Boards
CCGs
Local
Healthwatches
Public Health
England
Local
Authorities
Providers
FTs regulated and licensed by Monitor (economic) and all providers
regulated by CQC (care quality)
Who commissions what?
New organisations
Services
NHS England
primary medical services
dental services
community pharmacy
specialised services
offender health care
health care of the Armed Forces and their
families
CCGs
planned hospital care
rehabilitative care
urgent and emergency care
most community health services
mental health and learning disability services
Local Authorities
public health services
The role of nursing in
commissioning
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NHS England has a Chief Nursing Officer with
responsibility for quality assurance and patient
experience. Each of the organisation’s regional and
local offices also has a chief nurse
Each CCG must have at least one nurse on their
governing body
Public Health England has a professional lead for
nursing who is also Director of Public Health Nursing
at the Department of Health.
Changes affecting providers
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All NHS trusts will be expected to become FTs, with a
new Trust Development Agency set up to help them
achieve this safely.
Providers will be allowed to fail if they cannot remain
financially viable or provide safe care, though the
provision of essential services they provide will be
maintained so that patients being treated are
unaffected.
The private income cap for FTs has increased to
49%.
The changing role of Monitor
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Monitor will act as the economic regulator for FTs. NHS Trust
Development Agency will cover trusts until they can achieve FT
status. CQC will remain as the quality regulator.
Has a duty to protect, promote and improve the provision of
health care services.
Tasked with “tackling anti-competitive behaviour” and promoting
integration.
Will set prices and tariffs for NHS-funded care in conjunction
with NHS England.
Will license FTs and other providers of NHS-funded health
services.
Will scrutinise commissioner requested services (essential
services) to provide an early warning system in the case of trust
failure.
Care and Support Bill 2012
Proposed changes to social care include:
 establishing national eligibility criteria to reduce local
variation in access
 introducing a code of conduct and minimum
standards for care workers
 establishing a capital fund to develop specialised
housing for older and disabled people.
However, does not reform the way social care is
funded, and does not stipulate the need for qualified
staff or multidisciplinary teams
Draft Care and Support Bill 2012: Social
care reform
The RCN welcomes:
The RCN is concerned by:
National eligibility criteria to reduce
local variation in access
Fails to address the urgent and long
overdue issue of social care
funding.
Introduction of a capital fund to
develop more specialised housing
for older and disabled people
Without funding reform, many of the
Bill’s intentions are at risk (i.e.
prevention)
Aims to create a greater focus on
preventive and integrated social
care
Absence of recognition of
importance of registered staff input
into assessment and MDT working.
Plus lack of incentives to
encourages integrated care.
A new code of conduct and
Failure to regulate care workers
minimum standards for care workers
Care and Support Bill 2012
Changes to health care education:
 Responsibility for health education and training moving from
SHAs and Medical Education England to new bodies - Health
Education England (HEE) and local education and training
boards (LETBs)
 HEE will provide national leadership for education, training and
workforce development
 LETBs will bring together health care and public health
providers, the professions, local government, and the research
sector to plan and commission education in the local area
 The RCN has raised concerns about accountability and
transparency in the new system, and called for multiprofessional workforce planning over the longer term rather than
an annual cycle.
What the RCN is doing
The RCN continues to monitor the impact of the reforms
and advocate on behalf of patients and the nursing
family to help them deliver safe, high quality care.
The RCN is leading discussions and negotiations with
employers (old and new) and the Department of Health
to ensure that through this challenging period of
change, workforce and staffing issues are dealt with
quickly and effectively through partnership and that
there are transparent processes and systems
supporting staff throughout the change.
More information
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The Navigating the new NHS section of the RCN website has
briefings, fact sheets and an archive of our work on the
reforms: www.rcn.org.uk/nhsreform
If you have any concerns about the reforms and how they
affect you and your patients, please let us know so we can take
them forward on your behalf. Contact us via
policycontacts@rcn.org.uk
The RCN has produced a resource on clinical governance to
help members sustain and improve high standards of patient
care:
www.rcn.org.uk/development/practice/clinical_governance
If you are an RCN member and you are being directly affected
by the reforms, you can access advice and support from RCN
Direct on 0345 772 6100.