Editor's blog Wednesday 19 January 2011: Press conference launching Health Bill (rough transcript)

Below is a rough transcript of the Q&A session from the press conference launching the Health and Social Care Bill today. (If anyone would like to email in your observations on the Bill, please send to editorial AT healthpolicyinsight.com)

Q&A
Q: What do you say to those who say this is too much too fast; are nervous of effects of competition and loss of management talent?

AL: scale and pace – we were very clear in the White Paper that we wanted to achieve pace. The NHS is not in position it should be and so we should not let opportunity to improve outcomes be lost. outcomes not matching Euro levels; we spend £5bn on administration of NHS (excl in acutes); slower resource rises lie ahead. had to have reform process happen, and quick. listened in consultation, so longer phased transition for providers, more sense of piloting consortia, so in position where

On the abolition of PCTs – we're literally  only 6 months from the White Paper, HR framework and legislative framework visible. And we've agreed a  variable pace of change: in April 2013 when PCTs are abolished, NHSCB will have power to manage late-developing consortia's activity if there's a need to do so.

Trades Unions always attacked competition. argue on absolutely false basis. Duty of quality paramount in legislation. NHSCB and consortia have right to decide want to secure on basis of quality and outcomes if they wish to. Not legislating for competition on price, are legislating for right to compete on quality and outcomes.

Q: looks like c. 300 consortia – same as old pre-=06 number of  PCTs – why not just have let GPs lead PCTs?

AL: we never said 600/500. always clear wanted size and character defined by practices themselves. 28.5 million patients are now registered with pathfinders. could be 200-250. I don’t think the total number is surprising, interesting how varies from 19,000-650,000+ and legislation allows change. not entrenching structure and structure to meet needs (cancer will be commissioned at scales bigger than consortia). Idea we could have put GPs in charge of PCTs misses point, would leave large management tier in place. started with 909 PBC groups, 152 PCTs. idea to shift it down. abolition of PCTs = form follows function. most cost reductions are management costs.

Q: The schedule says that the NHS Commissioning Board can regulate its own procedure. Completely? Also, it says that the SoS will appoint NHS Commissioning Board chair and 5 members of the board; will approve its CE; can suspend NEDs and will decide their pay. How is this 'liberating'?

AL: That is a lot of power: as SoS, my job is to appoint excellent people in the NHS Commissioning Board and independent regulator - not tell them in detail what to do. It's according to the mandate the SoS sets the NHSCB, not just finance and mandate related to achievement of outcomes. You should focus more on the commissioing board's responsibility for outcomes; less on structure. This is not imposing detailed structures; more on specific duties and responsibilities. Their relationship with SoS will be important as SoS sets instructions for the commissioning board.

Q: patients can choose GP, can they hoose consortia?

AL: if they change GP practice, they may or may not change consortia. the essence of the choice is that of GP practice, and there will be competition between practices.

Q: on choice – what if a patient wants to choose something their GP doesn’t wants to commission?

AL: Bill outlines responsibility onto consortia to avail choice. freedom to refer will be on basis of contracts. patients should expect that if there’s a wiling provider of a service, there will be a contract for provision of that service.

Q: So can consortia specify nature of service want provided for population?

AL: yes they can. I've been talking locally with people over their plans for an integrated diabetes care for NW London, can decide want integrated service, so if want to be provider, have to meet that spec. Having specified the service and tariff, they can't say only provider X can do it, any who can meet the quality and spec can offer to provide.

Q: what if a patient says they do not want that integrated service?

AL: No. Choice of referral. responsibility and power to manage service

Q: how does this Bill increase competition and private bids for NHS work?

AL: strictly speaking, it doesn’t. Post-election OF revision June reintroduced any willing provider concept. Labour moved away from AWP to NHS preferred provider, so the NHS were allowed to get it wrong twice, which is great from patients’ point of view – please note that I’m being ironic here. There is a right for choice within limitations. So much doesn’t change, but for private sector, it does make clear that competition rules will not be at SoS's day-to-day political whim, turns come and gone of the past (as politicians do) into something stable, so there's a consistent, stable competition framework. for providers, sets out independent regulator with a competition responsibility to create a level playing field, not contracts with guaranteed volumes of private activity at higher  than NHS price.

Q: how stop GP consortia creating own expensive bureaucracy.?

AL: we will set consortia running cost limits. PCTs got budget and could set on services for patients or on selves. Money will have RCL. Will be running cost total for NHSCB and consortia in total. I assume broadly ion a percentage basis. If for all consortia, anticipated c. £25-35 per head. If £25 per head, that's £1.3 billion across England – likely to be 2% of total budget. They will be managed against total budget and limit.

Q: Do you believe voters expected this reorganisation?

Simon Burns: look at the Lib Dems’ and our manifestos – Lib Dems promised abolishing SHA, ours (pages 45-7) was advocating comm. of services by GPs, and take out day-to-day political interference on running NHS, both committed to Any Willing Provider, Andrew Lansley’s pre-election speeches, quite clear his vision of NHS not micro-managed by politicians, getting on and running services. Not surprise as anyone interested in finding out.

Q: This week’s report from the Health Select Committee suggests otherwise.

SB: That’s as maybe: I’m telling you the facts. If health were a major priority of an individual in the general election, they’d have had no problem seeing what AL wanted when he came into power. Some have talked about the NHS not dominating the general election campaign campaign. Politicians don't determine day-to-day agenda of election campaign, we made it plain if you got Conservative government, coalition agreement, real-terms increase in funding, and NHS would remain based on core Nye Bevan 1946 principles. Frequently and vigorously put forward. Didn’t hide wanted to improve health service, and get to basing things on health outcomes; not politically-distorting targets.

Paul Burstow: The idea there's no mandate as this was not in our manifestos has come from organisations that just didn’t read the manifestos. Imp thing with HSC useful points we take on board. coalition agreement was very clear. All previous reorganisations have been about centralising power in this place (DH). This one does the reverse.

Q: What if private providers cherrypick easy cases? In a market, unpopular organisations go bust – are you prepared to let that happen, or will the new risk pool bale consortia and FTs out?

AL: now under tariff, even new iteration, grouping under single price when actually is a differentiation. changes to PbR are part of this legislation. intend PbR to develop by having a much clearer relationship of costs to procedures or spells, so cost and tariff properly related. can’t just take all easy ones costing 30% less than hard ones. will push for tariff to be on year of care / care pathway basis (as for Cystic Fibrosis in the current Operating Framework, done by CF Trust monitoring standards and quality and assessing patients’ needs, said they could design it if we helped – and so we did).

Can providers go bust? yes, can and do now. in NHS get baled out. now will have transparent stat system in place via regulator who can step in and maintain essential designated services. Reforming FT legislation a tremendous opportunity to get really right.

Q: Any limits on private healthcare being involved

SB: not about policing or lifting limits, not boxing in. we seek providers who do necessary quality of acre ot be able to compete for providing care, not like comp tender on price, but on quality. more than one, and consortia can then choice, so driving up quality and efficiency.

Q: Your Coalition Programme envisaged PCTs having a role.

PB: neither manifesto set out. act of coalition and blending 2 sets agreements for govt threw up issue of establishing comm. being led by GPs, wanted to look at opportunity to move PH into local govt, so pull levers on causes of ill-health, leaving residual PCT role assessing pop need, and passing action on to PBC consortia, which didn’t seem to warrant legal entity. nor deal with greater democratic accountability, so we put forward proposals for health and wellbeing boards, to have key relationship with NHS. Understated has been extent to which this measure integrates health and social care in interests of delivering better health and social care

Q: You talked about removing politicians from the process – is Monitor an independent statutory body? Banking function DH? Independent reorganisation boards – will you step in? GPs 1 in 8 now earn more that £250K; Table 6 is a bit unclear on the source of £10 bn of benefits?

AL: Monitor is independent, that's clear in the Bill. Banking function at AL from DH and will be transparent rules, will be transparent commercial decision if wish to access banking function. GPs’ pay – these numbers how many earn more than PM, hear DH and NHS have many such GPs and consultants – from my POV I want more clinical leadership, senior public servants and clinical leads to provide more leadership. NHS managers are and will remain well paid in management of commissioning activities. Not abolishing impact assessment. Calculation of risk assessment long and techie, but do read it. Assessing which staff in PCTs go away, we think £1.4 bn repaid in saved in 2 yrs. PCTs net today have c. 50,000 administrators and 13,000 managers so 1 manager in a PCT for every 3 GPs,. will be managerial response.

Q: what about the IRP?

AL: major service decisions will stil come to me if local Overview and Scrutiny Committees choose that external scrutiny and the IRP cannot resolve the difference of opinion.