The 2012 NHS White Paper

The health White Paper Equity and Excellence: liberating the NHS outlines the government's vision for the NHS. It re-iterates the government’s commitment to an NHS available to all and free at the point of use and outlines the principles on which the proposed reforms are based.

The vision is of an NHS that is patient centred: a system that provides world class care, reduces inequalities in care, is more transparent, gives more say to citizens, works better across boundaries and has a smaller bureaucracy.

A further White Paper will set out the details of the government's proposals on public health later in 2010 and a commission for the funding of long-term care and support has been established.

The health White Paper promises an NHS that is 'genuinely centred on patients and carers' and that 'gives citizens a greater say in how the NHS is run'.

It embraces the principle of 'shared-decision making' under which patients make joint decisions about their care with their clinicians, and promises 'an information revolution' for patients. Wider use will be made of tools such as patient-reported outcome measures (PROMS) and patient experience surveys. Hospitals will be required to tell patients if something goes wrong while they are under their care.

Under the proposals published in the health White Paper, patients will be offered increased choice, including the choice of a named consultant for elective care (where clinically appropriate) by April 2013. A national consumer organisation called HealthWatch England (located within the Care Quality Commisision) will be created, which will advise on information that is most useful to patients, and propose investigations of poor services. Local HealthWatch bodies (replacing local involvement networks) will advocate for patients and carers within local authorities.

The paper provides details of how the NHS is to be held to account against 'clinically credible and evidence-based outcome measures'.

A new NHS Outcomes Framework (being consulted on in Transparency in outcomes – a framework for the NHS) will include a set of national outcome goals determined by the Secretary of State. These will cover the three domains of quality, safety and patient experience. The NHS Commissioning Board will be held accountable for their delivery and will work with GP consortia to deliver improvements against the selected outcomes.

The National Institute for Clinical Excellence (NICE) is tasked with developing 150 quality standards for the main pathways of care, which should be 'reflected in commissioning contracts and financial incentives'. These will be similar to the stroke quality standard already published by NICE.

The development of best-practice tariffs will be accelerated and the Commissioning for Quality and Innovation (CQUIN) framework will be extended to support local quality improvement goals. Commissioners will be able to withhold payment for poor-quality care.

The reforms set out in the paper are intended to 'liberate professionals and providers from top-down control' and to locate the headquarters of the NHS 'in the consulting room and the clinic'.

Under the proposals currently set out in the Health and Social Care Bill 2011, every GP practice will have to join a clinical commissioning group (CCG). These will be created as new statutory bodies, with a 'maximum management allowance' and an accountable officer. The NHS Commissioning Board will allocate budgets to CCGs and hold them to account for their use of resources and the outcomes they achieve. In turn, the Secretary of State will hold the NHS Commissioning Board to account in maintaining financial control and on delivering improvements in choice and patient involvement.

Within local authorities, statutory health and wellbeing boards will be responsible for ensuring that the commissioning of NHS services, social care and health improvement is joined up. The powers that enable joint working between the NHS and local authorities will be extended.

All existing NHS trusts will be supported to become foundation trusts, with the opportunity to become 'employee-led social enterprises'. Employers will have the right to determine pay for their own staff (as foundation trusts do currently).

Monitor and the Care Quality Commission (CQC) will run a joint licensing programme for all providers of NHS care to ensure continuity of services and to maintain essential levels of quality and safety.

The paper re-iterates the government's commitment to increase health spending in real terms in each year of this parliament, while recognising that this represents a challenge to the NHS (which has received increases in funding of an average of 4 per cent per year since its inception).

The existing Quality, Innovation, Productivity and Prevention programme (QIPP) will continue 'with even greater urgency' but leadership of the programme is to be devolved to local authorities and GP consortia as soon as possible.

Management costs will be cut by 45 per cent and proposals to abolish some arms-length bodies have been published (see Review of arms length bodies to cut bureaucracy). Primary care trusts and strategic health authorities are to be abolished and the Department of Health is to cut its budgets for centrally managed programmes.

Providers will be free of central management, and the system of economic regulation overseen by Monitor will 'drive efficiency'. Monitor will have powers to set efficient or maximum prices for NHS-funded services 'where necessary' and will have the power to apply competition law to both publicly and privately funded health and social care.

The government will not bail out failing commissioners, nor will it provide additional funding for failing providers. GP consortia will be required to take part in risk-pooling arrangements and providers of essential services may also be required to do so, to ensure that should a provider become financially unsustainable Monitor will be able to keep services running without recourse to the Department of Health.