They believe it is vital to make these changes to enable the NHS to meet the unprecedented challenge it faces of finding 4% annual efficiency savings over the next four years.
In their latest review of NHS Commissioning, MPs on the cross-party Commons Health Committee recommend a number of significant changes to the Health and Social Care Bill, currently before Parliament.
The Committee's Chairman, former Health Secretary Stephen Dorrell MP, says:
"We believe it is crucial to get the reform of NHS commissioning right if the service is to confront the massive financial challenge it now faces. Our report contains a set of practical proposals to strengthen the Health and Social Care Bill and make it better able to meet the Government’s objectives.
Our proposals are designed to ensure that NHS Commissioning involves all stakeholders – GPs, certainly, but also nurses, hospital doctors, and representatives of social care and local communities. We believe this broadening of the base for commissioning is vital if we are to achieve the changes that are necessary to allow the NHS deliver properly coordinated healthcare".
The most significant proposals include:
Local Commissioning Boards
Local NHS commissioners are statutory bodies responsible for a large proportion of public expenditure; they should be required to comply with the highest standards of governance and accountability.
In order to satisfy this standard each commissioner should be required to establish a Board where GPs should form a majority of membership but other places should be reserved for:
- A professional Social Care representative
- An elected member (a councillor or directly-elected Mayor), nominated by the local authority
- A nursing representative
- A representative of hospital medicine
- A public health expert nominated by the Director of Public Health
Scrutiny and the patient's voice
The Committee believes that local authority scrutiny of health services should continue and welcomes the extension of local authorities' health scrutiny powers.
MPs recommend that NHS commissioners should be given a legal obligation to consult Healthwatch, and that Healthwatch should have a legal obligation to consult with patients and patient representative bodies.
The Committee recommends that all NHS commissioners should have a Chief Executive and a Finance Director, both of whom should be members of the Board.
The Committee recommends that all NHS Commissioners should have an independent chair, appointed by the NHS National Commissioning Board.
Meetings and Papers
The Committee recommends that the Boards of NHS Commissioners should be required to meet in public, publish their papers and comply with the rules of the Committee on Standards in Public Life with regard to conflicts of interest amongst board members.
Accountability to the NHS Commissioning Board
The Committee recommends that NHS Commissioners should be held to account by the new NHS National Commissioning Board through a clear system of authorization and assurance.
A new name
The Committee concludes that the Government's plan to call local commissioning bodies "GP Consortia" is misleading. It proposes that these bodies should be referred to as "NHS Commissioning Authorities".
Health and Wellbeing Boards
The Committee believes that its own proposals would mean that there is no need to proceed with the establishment of Health and Wellbeing Boards.
Commissioning of Primary Care
The Committee also believes that its proposals would mean that there is no need to separate the commissioning of primary and secondary care – as currently proposed in the bill. The Committee proposes that NHS Commissioning Authorities should be responsible for commissioning primary, secondary and community healthcare, as well as for creating robust links with social care.
Commenting further Stephen Dorrell says:
"Ever since 1948 the NHS has suffered from an artificial distinction between primary and secondary care. Instead of entrenching this distinction further, this is an opportunity to abolish it for good – and create a single, integrated health service which is able to provide properly coordinated health and social care to all patients.
It is an opportunity to deliver greater efficiency and high quality at the same time. It is a 'win-win'; what is the argument against?"