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DH:  While a ‘free at the point of delivery’ NHS should be ‘sacrosanct’ that doesn’t mean ‘how it is provided’ should be - Plans to modernise the National Health Service and ‘put patients at the heart of everything it does’ were set out in the Health and Social Care Bill, published last week.  Under the new measures there will, for the first time, be a defined legal duty for the NHS & the whole care system to ‘improve continuously the quality of patient care in the areas of effectiveness, safety, and - most importantly - patient experience’.

The Health and Social Care Bill 2011 includes proposals to:
* bring commissioning closer to patients by giving responsibility to GP-led groups
* increase accountability for patients & the public by establishing HealthWatch and local health & wellbeing boards within local councils
* liberate the NHS from political micro-management by supporting all trusts to become foundation trusts and establishing independent regulation
* improve public health by creating Public Health England
* reduce bureaucracy by streamlining arms-length bodies

The plans are meant to improve the NHS in five key ways:
* patients would be more involved in decisions about their treatment & care so that it is right for them - there will be ‘no decision about me without me’
* the NHS would be more focussed on results that are meaningful to patients by measuring outcomes such as how successful their treatment was and their quality of life, not just processes like waiting list targets
* clinicians would lead the way - GP-led groups will commission services based on what they consider their local patients need, not on what managers feel the NHS can provide
* there will be real democratic legitimacy, with local councils and clinicians coming together to shape local services
* they will allow the best people to deliver the best care for patients - with those on the front-line in control, not Ministers or bureaucrats.

The proposed measures will also ‘save the NHS over £5bn by 2014/15’ and then £1.7bn every year after that - enough money to pay for over 40,000 extra nurses, 17,000 extra doctors or over 11,000 extra senior doctors every year.  The majority of the savings would come from a significant reduction in bureaucracy following the abolition of SHAs & PCTs and a reduction in management staff by an estimated 24,500 posts.
Press release ~ Health and Social Care Bill 2011 ~ NAO: National Health Service Landscape Review ~ TUC press release ~ The King's Fund comments on the publication of the Health and Social Care Bill ~ Civitas: Risk, Equity and Excellence ~ LGA’s press release ~ Monitor’s press release ~ Press release from Patients Association ~ Socitm’s press release ~ BHF’s press release ~ Health Committee of the House of Commons publishes a report on NHS Commissioning concluding that more effective commissioning is key to delivery of efficiency gains ~ The King's Fund comments on the Health Select Committee's report on commissioning ~ NHS Confederation stimulates debate about the risks associated with the Government's proposals for health reform ~ Related DH press release ~ UK medical advances ‘bogged down in red tape’, says report ~ The King’s Fund responds to National Audit Office report on NHS hospital productivity ~ KF comments on the publication of the NHS Outcomes Framework ~ Quality accounts need re-think to support information revolution ~ KF welcomes GP pathfinder announcement ~ KF response to the Health Select Committee's public expenditure report ~ PCT 'meltdown' threatens a return to rationing  ~ Behavioural Insight team launches health report ~ Practice Based Commissioning GP practice survey ~ The principles of GP commissioning: A GPC statement in the context of ‘Liberating the NHS’ ~ National Association of Primary Care ~ West Practice Based Commissioning Group ~ Related previous press release ~ Civitas: Moves to transfer commissioning responsibility to GPs could cost the NHS its £20bn efficiency savings target & worse ~ Related subsequent Civitas commentary ~ Giving GPs budgets for Commissioning: What needs to be done? ~ The 'Patchwork Privatisation' of our Health Service: A users' guide ~ Putting commissioning into practice (Audit Commission, 2007) ~ A prescription for partnership: engaging clinicians in financial management (Audit Commission, 2007) ~ The Impact of NHS Re-Organisation on Service Commissioning Costs: A Welsh Case Study ~ A Systems View of NHS reorganisations - the pain and cost of boldly going where we have been before ~ Pathfinder Learning Network ~ Summary of the government’s Command Paper on health: How does it relate to National Voices’ positions? ~ GP pathfinder consortia by Strategic Health Authority region

DemosHaving a baby will not ‘solve’ marital problems - Stable single-parented families provide a better home environment for children than rowing married couples finds a new report from the think tank Demos.  Becoming parents for the first time is a difficult transition time for couples, with between 14 & 27% of couples divorcing or separating in the first 5 years of a child’s life. 

Only up to a third of couples are happier in their relationships after their first child is born (between 18 & 33%).  Evidence showed that highly conflictive relationships can be more detrimental for both children and the parents than divorce or separation.  Arguing parents – and the instability associated with this – had a worse effect on children’s outcomes than single-parented children with stable home lives.

The report argues that preparing new parents for relationship problems and providing relationship support can limit the negative impact of family breakdown on children.

As trusted experts, Health Visitors should be trained to provide couples with relationship advice to reduce the risk of first-time parents breaking up.  However, between 1999 &2009, the total number of full-time health visitors decreased by 19%. In 2009, 245 fewer full-time health visitors were employed than in 2008, leaving numbers of health visitors at an all-time low.
Press release ~ The Home Front ~ Demos: Children's perspectives on family life ~ Children’s Commissioner ~ 2009 Demos report: Building Character ~ Gingerbread ~ One parent Families Scotland ~ Civitas: Experiments in Living – The fatherless family ~ CPHVA ~ Directgov: Financial help for lone parents ~ Family Nurse Partnership (FNP) programme ~ ~ Facing the Future: A review of the role of health visitors ~ Child Development and the Role of the Health Visitor ~ Netmums: Families Need Health Visitors ~ CPHVA: he Universal Health Visiting Service ~ The Distinctive Contribution of Health Visiting to Public Health and Wellbeing ~ The crisis in health visiting (Facts and figures) ~ The Distinctive Contribution of Health Visiting to Public Health and Wellbeing: A Guide for Commissioners ~  Getting it right for children and families: Maximising the contribution of the health visiting team ~ Allen review recommends early intervention body to promote best practice (scroll down for link to report) ~ CH4: Do government schemes to head off social problems work?  ~ Related press release from DPM ~ DfE response to report

DHLet’s make the fines payable from the top managements’ pay & performance bonuses! - More than 11,000 patients were placed in mixed sex accommodation in hospitals providing NHS services in December 2010, according to new data published by Health Secretary, Andrew Lansley. 

The figures come as the Health Secretary announces that hospitals found in breach from April 2011 will be fined £250 for each patient affected and each day that they stay in mixed sex accommodation.
FDAOne needs sufficient ‘gamekeepers’ to minimise ‘poaching’ - A committee of senior MPs were warned last Wednesday by senior tax officials to expect an upsurge in tax avoidance and a widening tax gap if planned cuts to tax collection budgets go ahead.  The Association of Revenue and Customs (ARC), the union representing senior managers in HM Revenue & Customs (HMRC), told the Treasury Sub-Committee that proposed budget reductions could undermine HMRC's ability to identify, prioritise and deal with those avoiding paying tax.

HMRC has already suffered significant staffing reductions, from 99,179 staff in 2004-05 to 68,037 in June 2010.  The last Spending Review announcement of a further 15% cut in expenditure will further erode staff capacity, and their ability to close the tax gap.

The latest estimate of the gross tax gap for 2008-09 shows that it has increased by £4bn compared with the previous year, and stands at approximately £52bn.  ARC believes that if £2bn of the estimated tax gap were to be recovered, it would provide valuable extra resources - for schools, hospitals and other public services.
Press release ~ Treasury Sub-Committee's inquiry into the Administration and Effectiveness of HMRC ~ Earlier related FDA press release ~ FDA ~ Association of Revenue and Customs (ARC) ~ HMRC 2008 Autumn Performance report ~ 2009 report ~ HMT: Government announces tax avoidance clampdown ~ Related PCS press release ~ Tax Justice and Jobs: The business case for investing in staff at HM Revenue and Customs ~ Tax Justice Network ~ HOOT - Hands Off Our Tax offices ~ HMRC - Anti Avoidance Group: JITSIC (Joint International Tax Shelter Information Centre)

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