Healthcare Features
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The government will extend local authorities’ scrutiny powers to cover all NHS-funded services, the Health Secretary Andrew Lansley has announced.
Councils will also have greater freedom in how these powers are exercised, according to the Department for Health’s Liberating the NHS: Legislative Framework and Next Steps.
The publication follows a consultation that received some 6,000 responses, and means the Health and Social Care Bill could be introduced in the New Year. Another key change as a result of the feedback is that commissioning of maternity services will now sit with GP consortia.
The Department for Health has also published the PCT Allocations and NHS Operating Framework for 2011/12, setting out what NHS organisations must focus on. This includes:
- “the need to continue to improve performance, for example on waiting times
- Primary Care Trusts streamlined into clusters, working with GP practices and emerging GP consortia on commissioning as well as reducing running costs, and
- the role of the NHS Commissioning Board, which will operate in shadow form from next year to ensure an efficient and effective transition.”
Lansley also announced that PCTs would receive £89 billion of funding to spend next year on commissioning services – an increase of £2.6 billion from 2010/11.
He said: “I am proud that we are living up to our commitment to the NHS – the total allocations to Primary Care Trusts will increase next year by 3% on average, with not less than 2.5% and up to 4.9% increase for individual PCTs. It provides a strong platform to sustain and improve NHS services.
“But in order to meet rising demands and deliver improving outcomes for patients, we need to get the best value from our protected health budget and make every penny count for patients. That means cutting out waste, reducing bureaucracy and simplifying NHS structures so that we are able to invest more in improving frontline care.”
The Health Secretary insisted that the government’s reform agenda was on track, pointing to last week’s unveiling of 52 GP consortia to act as pathfinders when it comes to commissioning services.
Lansley said he expected similar shadow forms of Health and Wellbeing Boards to emerge. “The Health and Social Care Bill will be presented early in the New Year,” he added. “Its purpose is clear: a more responsive, patient-centred NHS, which achieves outcomes that are among the best in the world. It provides certainty, through a clear legislative framework to support that ambition, with increased autonomy and accountability at every level in the NHS.”
The Local Government Association said it was pleased that many of its proposals had been included in the government’s latest announcement.
Cllr David Rogers, chairman of its community wellbeing board, said: “The LGA has consistently stressed that key to the shake-up’s success is local leadership and accountability. We called for the new Health and Wellbeing Boards to be given teeth and put on a statutory footing, and this has happened.
“We fought hard against plans to scrap separate health overview and scrutiny committees, and our arguments have hit home. Extending formal council scrutiny to cover all NHS-funded services is a positive move, as is the decision to give health and wellbeing boards powers to make sure NHS commissioners work together with town halls to improve the health of their communities.
“Our members were also concerned the new system may not be truly ready before the abolition of primary care trusts in 2013. That our calls to speed up the introduction of wellbeing boards and phase in new GP consortia with pilot schemes have been acted on is reassuring. And the move to make GP commissioning decisions more transparent can only be a good thing.”
Rogers said the LGA would await clarification on funding and would thoroughly scrutinise the Health and Social Care Bill when it is released “to ensure it mirrors the government’s stated intention of freeing up councils and communities to decide how best to improve health and wellbeing locally, without needless interference from the centre”.
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The Office of Fair Trading has launched a study looking into commissioning and competition in public sector procurement.
The research will look at commissioning across a range of public services, including health, education, welfare and justice.
The OFT said the study was designed to help government buyers “promote competition in markets in order to realise better value for money” and to provide constructive and practical guidance to policymakers and commissioners of public services in local, central and devolved government “on how to take due account of competition issues in the procurement of public services”.
As part of the project the research team will identify examples of best practice in competitive procurement, and consider the impact of issues such as payment by results, the role of SMEs and the third sector and the delivery of services by mutuals.
The review will consider three key questions in particular:
- What are the key challenges faced by commissioners of public services when moving from self-supply to third party contractors?
- What, if any, are the trade-offs between involving SME and newly formed enterprises in the tendering process and ensuring successful delivery?
- If contractors are made responsible for managing the supply chain, how far should they be required to maintain competition down the supply chain?
Researchers will also consider the parallels with competitive commissioning of private services and make international comparisons.
The study is set to be published in March 2011.
Sonya Branch, the OFT’s Senior Director of Services and Public Markets, said: “By collecting evidence on the impact of specific purchasing practices, our aim is to help policymakers and procurers preserve and promote competition in public services markets.
“Used in the right places and in the right way, vigorous competition among public services providers can increase efficiency, improve the quality and range of services on offer, and achieve a better allocation of resources. In the long-term it can also lead to greater innovation, and substantial savings for the taxpayer.”
The OFT recently set up a new group looking at public markets to reflect its greater focus on the public services sector.
In July, OFT chief executive John Fingleton called for competition to be “hard wired” into the commissioning and procurement of public services to ensure its full benefits are gained.
He also warned of the dangers of being locked in to long-term contracts that make it difficult to switch supplier, and of potential collusion among tenderers.
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The Social Work Reform Board (SWRB) has published the first single, national set of professional standards for social workers, outlining what level of service the public can expect from them, and recommended an overhaul of social worker education and training.
The board, which was set up a year ago to advise the government on reforming the social work system, said that the proposals would bring the social work profession in line with other public sector professionals like doctors, nurses and teachers.
It said that the core themes of the overarching professional standards framework should be:
- Professionalism: identify and behave as a professional social worker, committed to professional development.
- Values and ethics: apply social work ethical principles and values to guide professional practice.
- Diversity: recognise diversity and apply anti-discriminatory and anti-oppressive principles in practice.
- Rights, justice and economic wellbeing: advance human rights, and promote social justice and economic well-being.
- Knowledge: apply knowledge of social sciences, law and social work practice theory.
- Critical reflection and analysis: apply critical reflection and analysis to inform and provide a rationale for professional decision-making.
- Intervention and skills: use judgement and authority to intervene with individuals, families and communities to promote independence, provide support and prevent harm, neglect and abuse.
- Contexts and organisations: engage with, inform, and adapt to changing contexts that shape practice. operate effectively within own organisational frameworks and contribute to the development of services and organisations. operate effectively within multi-agency and inter-professional settings.
- Professional leadership: take responsibility for the professional learning and development of others through supervision, mentoring, assessing, research, teaching, leadership and management.
The SWRB also recommended that social work education should also be reformed to improve the quality of social work degrees, with more rigorous selection criteria. It added that the design of social work courses should involve people who have experienced social services, so that the training properly reflects the real-life reality of the job.
The SWRB's report Building a Safe and Confident Future – One year On said that employers should be expected to set out standards of supervision and support for social workers, to include:
- making sure the right number of social workers with the right level of skills and experience are available to meet the level of demand
- managing workloads and caseloads so that social workers are not overworked
- giving social workers the practical resources they need to do their jobs
- creating development opportunities for social workers to give them greater experience and skills.
Moira Gibb, CBE, Chair of the Reform Board and Chief Executive of the London Borough of Camden, said:
“A year ago the Social Work Task Force recommended comprehensive reform of the social work system so that in the future, social workers are more consistently able to practise confidently and safely. Since then, the Social Work Reform Board has been working to make the task force's recommendations a reality.
“This report, the first from the Social Work Reform Board, marks a staging post in the journey of social work reform and a foundation for helping us, together, to deliver a better future for social work. The proposals published today should help every individual social worker, every employer of social workers and everyone who educates or trains social workers to do their work better in the interests of those who need and use social work.
“The government supports the work of the Social Work Reform Board and is urging the sector to get involved in the next steps towards implementing these important and necessary changes.”
Tim Loughton, Children’s Minister, said: “I welcome the Social Work Reform Board’s proposals, which are an important step for social workers to gain the status and respect they so rightly deserve. We are committed to making a real difference to frontline social work and to implementing the Social Work Reform Board’s recommendations. That is why in the new year we will be announcing significant funding to implement the reforms and Professor Munro’s recommendations to improve child protection.”
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Up to 73,000 local government jobs could go in the next financial year, research by CIPFA has suggested.
The brunt of these job losses are likely to be felt by managerial and back office staff, but one-third will affect frontline, non-managerial roles.
The survey of 166 councils also found that almost half of local authorities (44%) expect to cut their expenditure on capital investment projects by more than 20% in their 2010/11 budgets.
The other areas of expenditure under most pressure are:
- Property and assets (30% of respondents expect total cuts in excess of 20%)
- Finance/HR/IT (29%)
- Community safety (28%)
- Economic development and regeneration (28%)
- Public libraries, archives, arts, museums and heritage (27%)
- Leisure, parks, open spaces, sports and recreation (27%)
- Trading standards (18%)
- Statutory services – licensing and registration (17%)
- Highways, transport and parking (16%)
The CIPFA survey also reveals widespread acceptance of the need to collaborate with other authorities.
Some 96% of the respondent authorities said they were exploring shared services with other councils. More than half (52%) said they were developing partnerships with other local public service bodies, while a similar percentage (50%) are working on partnerships with the voluntary sector.
Outsourcing with a commercial partner is meanwhile being explored by 45% of local authorities. A third are also examining the scope for shared services with health bodies.
Steve Freer, CIPFA chief executive, said: “These are not final budget figures. But they illustrate the scale of the significant cuts which councils are contemplating and which will be firmed up as 2011/12 budgets are finalised over the next few weeks.”