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26.Jul.2010

The regulation of social workers will be transferred from the General Social Care Council to the Health Professions Council as part of a shake-up of health quangos, the government has announced.

The review by Health Secretary Andrew Lansley also concluded that the Care Quality Commission should be retained as a quality inspectorate across health and social care.

The CQC will operate a joint licensing regime with Monitor, which will act as an economic regulator. The Commission will in addition become the host organisation for HealthWatch, a new consumer body that is intended to play a key role in the revamped NHS.

Also being retained is the National Institute for Health and Clinical Excellence, which will have an expanded scope to include social care standards.

Under the proposals, the number of health-related arm’s length bodies (ALB) will be reduced from 18 to between eight and ten.

Key developments include:

• The abolition of the Health Protection Agency, which protects the health and wellbeing of the population. Its functions will be transferred to the Secretary of State as part of the new Public Health Service.
• The removal from the sector of the Council for Healthcare Regulatory Excellence, which oversees professional regulators. It will be turned into a self-funding body with an extended role to set standards and quality assure voluntary registers.
• The retention of the NHS Litigation Authority, which handles negligence claims and works to improve risk management practices in the NHS. An industry review will be commissioned to see if there are potential opportunities for greater commercial involvement.

The Health Secretary said: “Over the years the ALB sector has grown to the point where overlap between organisations and duplication of effort have produced a needless bureaucratic web. By making sure that the right functions are being carried out at the appropriate level, we will free up significant savings to support frontline NHS services.”

Lansley also unveiled a consultation paper – Regulating Healthcare Providers – on plans to free up foundation trusts.

The proposals include making it easier for a foundation trust to merge or take over another trust, and giving more flexibility to foundation trusts to allow greater staff and patient involvement “with the possibility of some smaller organisations being led only by employees”.

The consultation paper also proposes removing the statutory private income cap to give trusts opportunities to expand the services they offer to patients “but ensuring that they remain focused on providing NHS services”. Statutory borrowing limits that are not imposed on voluntary or private providers will also be removed.

Lansley said: “In order to improve health outcomes and the service the NHS gives to patients, it must be free from the shackles of central control.”

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22.Jul.2010

The government has fleshed out its plan to hand local authorities a greater role in healthcare, launching two consultations on key proposals contained in its recent White Paper on the future of the NHS.

The consultation papers – Local Democratic Legitimacy in Health and Commissioning for Patients – set out how patients, councillors, local authorities, public health experts and others will work alongside GP consortia, which will now make most commissioning decisions.

Proposals include establishing a statutory partnership board or “health and wellbeing board” within local authorities.

The Secretaries of State for Health and Communities and Local Government, Andrew Lansley and Eric Pickles, said the partnerships, led by local authorities, would mean services “will become more responsive and be developed in ways that fit around the people who use them”.

The ministers added that patients and the public would have a stronger voice through local HealthWatch, a new patient group dubbed a “citizen’s advice bureau” for health and social care.

Under the scheme, within a ring-fenced public health budget local health improvement funds will be held by local authorities, with decisions about how this is spent taking into account all local issues that impact on well-being.

Pickles said: “For the first time in 40 years there will be local democratic accountability and legitimacy in the NHS. Elected councils will have a key role including commissioning HealthWatch services to guarantee patients a voice. As we push power away from Whitehall we will make the health service more answerable to patients, not politicians.”

In Local Democratic Legitimacy in Health, the government sets out how local authorities will have greater responsibility in four areas:

• leading joint strategic needs assessments (an assessment of the health and wellbeing needs of the population in a local area) to ensure coherent and co-ordinated commissioning strategies
• supporting local voice, and the exercise of patient choice
• promoting joined up commissioning of local NHS services, social care and health improvement, and
• leading on local health improvement and prevention activity.

The consultation paper says: “With the local authority taking a convening role, it will provide the opportunity for local areas to further integrate health with adult social care, children’s services (including education) and wider services, including disability services, housing, and tackling crime and disorder.”

Take up of current flexibilities to enable joint commissioning and pooled budgets has been relatively limited, the paper says. “It has tended to focus on specific service areas, such as mental health and learning disabilities,” it continues. “The full potential of joint commissioning, for example to secure services that are joined up around the needs of older people or children and families, remains untapped.”

The government believes there is scope for stronger institutional arrangements, within local authorities and led by elected members, to support partnership working across health and social care, and public health.

One option, the consultation paper says, is to leave it to NHS commissioners and local authorities to devise their own local arrangements. However, the government’s preferred approach is “to specify the establishment of a statutory role, within each upper tier local authority, to support joint working on health and wellbeing”.

The consultation paper argues that the advantages of such a statutory arrangement would be that it provides duties on relevant NHS commissioners to take part, a high-level framework of functions and therefore clarity of expectation about partnership working.

A statutory partnership board could also enhance the respective roles and responsibilities of participants and act as a vehicle and focal point through which joint working could happen, it says.

The functions of such a board would include a scrutiny role in relation to major service design, and the consultation paper proposes transferring across the statutory functions of overview and scrutiny committees.

The government insists that any requirements for a statutory partnership board would be minimal “with local authorities enjoying freedom and flexibility as to how it would work in practice”. Arrangements would need to be put in place in two-tier areas so that democratic representatives of areas below the upper tier can contribute.

Membership of the board would bring together “local elected representatives including the Leader or the Directly Elected Mayor, social care, NHS commissioners, local government and patient champions around one table”. Directors of Public Health, within the local authority, would also have a critical role. GP consortia will be represented, while councils could also choose to invite representatives from the voluntary sector and “other relevant public service officials”.

In cases where there is a dispute between commissioners and local authorities, health and wellbeing boards will have a power to refer the commissioning decision to the NHS Commissioning Board. If concerns still exist, then they will have a statutory power to refer cases to the Health Secretary.

Local Democratic Legitimacy in Health can be downloaded here.

Commissioning for Patients meanwhile seeks views on a on a number of areas including:

• How GP consortia and the NHS Commissioning Board can best involve patients in improving the quality of health services
• How GP consortia can work closely with secondary care, community partners and other health and care professionals to design joined-up services that are responsive to patients and the public
• How the NHS Commissioning Board and GP consortia can best work together to make effective and efficient commissioning decisions
• How the NHS Commissioning Board can best support consortia and ensure they achieve improvements in outcomes within NHS resources

It can be downloaded here.

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21.Jul.2010

The government has launched a commission on the funding of adult social care and support, acknowledging that the current system is unsustainable and urgent reform is needed.

The commission – which will be chaired by Andrew Dilnot, an economist and former director of the Institute of Fiscal Studies – has been asked to “examine and provide deliverable recommendations on:

• How best to meet the costs of care and support as a partnership between individuals and the state
• How people could choose to protect their assets, especially their homes, against the cost of care
• How, both now and in the future, public funding for the care and support system can be best used to meet care and support needs, and
• How its preferred option can be delivered, including an indication of the timescale for implementation, and its impact on local government (and the local government finance system), the NHS, and – if appropriate – financial regulation.”

The Health Secretary said the commission should examine a range of funding ideas, including voluntary insurance and partnership schemes. Funding models must be assessed on criteria including choice, fairness, value for money and sustainability, Andrew Lansley added.

He said that the recommended system must be consistent with the government’s deficit reduction plan, and be sustainable for the public finances in the long term. Any proposals will also have to be compatible with the government’s vision for care and support – “supporting personalisation, prevention and partnership and offering protection for people” – and take into account how appropriate housing and related services can better support people with disabilities and in later life.

He has asked Dilnot – who will be supported by two other commissioners, Lord Norman Warner and Dame Jo Williams – to report back by July 2011.

The government will then publish a White Paper, drawing together the commission’s conclusions with the work being done by the Law Commission, which is looking at how to create a single modern statute for social care.

The Health Secretary insisted that urgent reform was needed. Lansley said: “By 2026, the number of 85 year olds is projected to double. In the next 20 years we estimate that 1.7m more people will have a potential care need than today. We know that one in five 65 year olds today will need care costing more than £50,000, which could force many to sell family homes.

“The answer is clear – we must develop a funding system for adult care and support that offers choice, is fair, provides value for money and is sustainable for the public finances in the long term. I want to build momentum on this reform and expect to see legislation in front of Parliament next year.”

Care Services Minister Paul Burstow added: “The current system is unsustainable – it cannot go on as it is. The country needs a new settlement for social care.

“For too long social care reform has been a talking shop. Trade offs will have to be made but we are determined to build a funding system that is fair, affordable and sustainable.”

Dame Jo Williams has meanwhile emerged as the government’s candidate for the post of chair of the Care Quality Commission.

Lansley has asked the health select committee to hold a public pre-appointment scrutiny hearing and report on Williams’ suitability for the post. Williams is currently interim chair of the CQC, having succeeded Baroness Young, who resigned from the post in January this year.

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19.Jul.2010

The Local Government Ombudsman has published year-end reviews for all local authorities in England, outlining their performance in relation to complaints.

The reviews provide a summary of the enquiries and complaints received by the LGO, and the outcomes of those complaints. They also cover the local authorities’ response times and the level of liaison with the LGO.

In a statement, the Ombudsmen said they hoped that councils “will use the reviews in a positive way, as part of the corporate quality assurance and performance management processes.”

They added: “The reviews will also be of interest to local people in holding their council to account.”

In addition, the annual reviews update councils on developments at the LGO over the year. For 2009/10, these have included:

• The launch of a new schools complaints service in April 2010. The LGO has been considering parent and pupil complaints in four local authority areas – Barking and Dagenham, Cambridgeshire, Medway and Sefton. A further ten local authority areas are expected to join the pilot in September, with a full rollout of the LGO’s jurisdiction by September 2011.
• Preparations for the Ombudsmen’s new powers under the Health Act 2009 to investigate complaints about privately arranged and funded adult social care. These come into effect from 1 October 2010 (or when the Care Quality Commission has re-registered all adult care providers undertaking regulated activity).
• The Council First procedure, which was introduced in April 2009 and requires (with some exceptions) complainants to go through all stages of a council’s own complaints procedure before the Ombudsmen will consider the complaint.
• Training in complaint handling. The LGO plans to carry out a review of local authority training needs to ensure its programme helps councils improve their complaints handling.
• Proposals for introducing statements of reasons on individual decisions of an Ombudsman following an investigation of a complaint. The LGO has been carrying out more detailed work on its proposals, following consultation in 2009, and intends to introduce the new arrangements “in the near future”.

Annual reviews for the previous three years have also been placed on the LGO website. For more information, click here.

Details

13.Jul.2010

Local authorities will take on the health improvement functions currently carried out by primary care trusts in a radical overhaul of the NHS, the government has announced.

The White Paper Equity and Excellence: Liberating the NHS, published yesterday by Health Secretary Andrew Lansley, also said the coalition will simplify and extend the use of powers that enable joint working between the NHS and local authorities.

Other key announcements include the establishment of an NHS Commissioning Board to lead on achieving health outcomes and allocating resources, a network of GP consortia with responsibility for commissioning care, and a Public Health Service to cover public health evidence and analysis. All NHS trusts will become or be part of a foundation trust under the plans, with the government aiming to create “the largest social enterprise sector in the world”.

Local authorities will take on the function of joining up the commissioning of local NHS services, social care and health improvement. PCTs – and strategic health authorities – will be scrapped, most likely in 2013.

The government said the move would “realise administrative cost savings, and achieve greater alignment with local government responsibilities for local health and wellbeing”. The transfer of local health improvement functions will involve ring-fenced funding and accountability to the Secretary of State for Health.

Local authorities’ responsibilities “will include:

• Promoting integration and partnership working between the NHS, social care, public health and other local services and strategies
• Leading joint strategic needs assessments, and promoting collaboration on joint commissioning plans, including by supporting joint commissioning arrangements where each party so wishes, and
• Building partnership for service changes and priorities. There will be an escalation process to the NHS Commissioning Board and the Secretary of State, which retain accountability for NHS Commissioning decisions.”

The paper adds: “As well as elected members of the local authority, all relevant NHS commissioners will be involved in carrying out these functions, as will the Directors of Public Health, adult social services, and children’s services. They will all be under the duties of partnership.”

Representatives of Local HealthWatch – local involvement networks that will be part of a new independent consumer champion, HealthWatch England, based within the Care Quality Commission – will ensure feedback from patients and service users is reflected in commissioning plans. Local HealthWatch will be funded and accountable to local authorities.

The new arrangements will be delivered by “health and wellbeing boards”, which will take the place of the current statutory functions of health overview and scrutiny committees.

“These boards allow local authorities to take a strategic approach and promote integration across health and adult social care, children’s services, including safeguarding, and the wider local authority agenda,” the paper said.

The arrangements are also intended to give local authorities influence over NHS commissioning and corresponding influence for NHS commissioners in relation to public health and social care.

The paper said: “While NHS commissioning will be the sole preserve of the NHS Commissioning Board and GP consortia, our aim is to ensure coherent and coordinated local commissioning strategies across all three services, for example in relation to mental health or elderly care.

“The Secretary of State will seek to ensure strategic coordination nationally; the local authority’s new functions will enable strategic coordination locally. It will not involve day-to-day interventions in NHS services.”

The Department of Health said it will consult fully on the details of the new arrangements, which it claimed were about devolving powers from Whitehall to patients and professionals, and streamlining the NHS.  It expects £20bn in efficiency savings by 2014.

Patients will have more choice and control, based on the principle of “no decisions about me without me”, it said. Patients will be able to choose which GP practice to register with, regardless of where they live.

Health Secretary Andrew Lansley said: “The NHS is our priority. That is why the coalition government has committed to increases in NHS resources in real terms each year of this Parliament. The sick must not pay for the debt crisis left by the previous administration.

“But the NHS is a priority for reform too. Investment has not been matched by reform. So we will reform the NHS to use those resources far more effectively for the benefit of patients.”

Cllr David Rogers, Chairman of the Local Government Association’s Community Wellbeing Board, called for councils to be given a central role in the outcome of any NHS reorganisation.

He said: “They know their area best and working in partnership with health professionals are best placed to help improve the health of residents and respond to circumstances in their areas.

“Town halls want to promote healthy, active lifestyles and help people live longer, happier lives. With a long and proven history of addressing public health issues, they are ideally placed to deliver these goals and guarantee public involvement in local commissioning decisions."

Details

09.Jul.2010

A local authority social worker must author the pathway plan for a young person, not the individual’s personal adviser, a High Court judge has ruled.

In A, R (on the application of) v London Borough of Lambeth [2010] EWHC 1652 (Admin), the claimant argued that the council had failed to assess his needs and to produce a plan in accordance with the Children (Leaving Care) (England) Regulations 2001.

Under the regulations local authorities are under a duty to assess and meet the needs of eligible young people aged 16 and 17. They are also required to keep in touch with young people who have left care to make sure they receive help, work education, training or employment.

The duty runs until the young person is 21, or 24 if they are still receiving help with education, training or employment. Local authorities also have to review the plan every six months.

The plans cover issues such as accommodation, assistance in relation to education and training, financial support, health needs and so on.

A, who will be 19 in December, had previously been looked after by Lambeth. It emerged during the proceedings that his pathway plan had been exclusively prepared by his personal adviser, who acts as an intermediary between the young person and the council’s social services department.

Mr Justice Kenneth Parker ruled that this was unlawful. He said: “Untrammelled by authority, I would not have thought that a personal adviser, even if employed by the authority, may on his own discharge the statutory duty of carrying out an assessment or of making a plan.”

The judge added that the regulations suggested the personal adviser may only “participate” in the discharge of the local authority’s functions. This could legitimately mean the personal adviser taking the initiative in relation to a review and playing a very active role.

Oliver Studdert, the claimant’s solicitor at MG Law, said: “This judgment makes clear that social services cannot cease to be involved with children leaving care once they reach 18.

“The role of the personal adviser should always be to work with the young person and to play a negotiating role with social services on their behalf. All too frequently a personal adviser also plays the role of social worker, resulting in clear conflicts arising to the detriment of the young person.”