Health and Social Care Reform: a challenge and opportunity for the sector - by Morven Masterton

A commitment to health and social care has been a key pledge of the Coalition Government, evident even before it formed following last May’s General Election. Despite significant cuts across the public sector, last year the Treasury announced a 0.4% real terms increase to the NHS budget in the Comprehensive Spending Review, as well as promising to invest an additional £2 billion per year to support social care. The Government plans to meet rising levels of demand and to support improvements in quality and outcomes by realising savings through reduced administration costs and capital spending - reinvested to support the delivery of NHS services.  

Government health policy is being directed through the Health and Social Care Bill, now at Committee Stage in the House of Commons after its introduction to Parliament by the Secretary of State, Andrew Lansley MP, in January this year. The Bill takes forward the changes to the NHS set out in the Government’s White Paper: ‘Equity and Excellence: Liberating the NHS’ (July 2010) and its structural paper: Liberating the NHS: Legislative Framework and Next Steps - PDF (December 2010).

The Government’s proposal manifests itself in a wholesale reform of health services in England, described by NHS Chief Executive as so great that it would be “visible from space”. In its programme of modernisation, the Government seeks to devolve power to professionals, patients and carers; at its heart is the Secretary of State’s mantra, “no decision about me without me”. It is expected that such change marks a new era of personalisation and marketisation to the NHS.

So what do these reforms mean for charities, community groups and social enterprises involved in health and social care? The ‘marketisation’ of the health sector is expected to widen the number of providers. Based on the principle of ‘any willing provider’, there is new scope for charities, mutuals and social enterprises as well as private sector providers to supply services to the NHS under the new “right to bid”. With ambitious targets of 25% of all government contracts to be awarded to SMEs, including many community sector organisations, health policy is leading the Government’s agenda in opening up public services to new providers.

Under the new system, the NHS’s role will increasingly focus on commissioning while Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs) are being replaced by groups of GP practices - statutory bodies with financial accountability and commissioning responsibility - supported by and accountable to, a new independent NHS Commissioning Board. The Commissioning Board begins operating in April 2011 and will be up and running by April 2012.  It will be responsible for monitoring the quality of care provided and for promoting choice and patient and public involvement. New Local Healthwatch will act as the local consumer champion across health and social care, strengthening patient voice and opening up NHS commissioning decisions. If things go to plan, GP ‘consortia’ will be fully up and running by April 2013.

The Department of Health has already enabled pilot consortia (GP Pathfinders) to form to test out design concepts for commissioning. The Department has already announced 177 registered GP Pathfinders covering approximately two thirds of the population. A survey by GP magazine, Pulse, found that of the 25 most advanced GP pathfinders there are vastly different approaches to the Government’s health reforms. Some consortia are following an NHS-only policy in recruiting and commissioning whilst others plan to use external support – including back-office assistance in areas such as accountancy, tendering, contracting and human resources, and also in clinical areas, such as referral management.

Like many other new proposals, these measures are ground-breaking and their magnitude should not be underestimated. For civil society organisations the reforms have the potential of greater reach and greater impact, but they also bring new commissioning arrangements to understand and navigate and competitive practices which will be alien to many charities and community enterprises.

Many of the organisations which The Social Investment Business has helped over the past seven years provide health and social care services. By planning ahead voluntary organisations and social enterprises can position themselves in order to continue delivering the vital support they provide in their communities. The true extent of the impact cannot yet be foreseen but civil society organisations need to be prepared for the new environment and to remain led by the social outcomes they can achieve.

For more information about the Health and Social Care Bill visit the Department of Health’s website.

For more information about public sector reform as a whole see the Government’s Open Public Services White Paper to be published this month.

If you would like to get in touch with our policy team to find out more about our work please email policy@thesocialinvestmetnbusiness.org.