The delivery of health and social care has undergone major change to its core structures. Many of the changes have already taken place, but most took effect on 1 April 2013. These changes will have an impact on who makes decisions about NHS services, how these services are commissioned, and the way money is spent.
Primary care trusts and strategic health authorities have been abolished, and other new organisations such as clinical commissioning groups (CCGs) have taken their place. As of this week a total of 211 CCGs are responsible for £65 billion of the £95 billion NHS commissioning budget. All 8,000-plus GP practices in England are members of a CCG, putting the majority of the NHS budget in the control of frontline clinicians for the first time. The groups will include other health professionals, such as nurses.
CCGs will commission most services, including, planned hospital care, rehabilitative care, urgent and emergency care, most community health services and mental health and learning disability services. CCGs can commission any service provider that meets NHS standards and costs. These can be NHS hospitals, social enterprises, charities, or private sector providers.
To add to the mix are health and wellbeing boards; a new forum where leaders from the health and care system work together to improve the health and wellbeing of their local population and reduce health inequalities. Each top tier and unitary authority has its own health and wellbeing board. Board members will work together to understand their local community’s needs, agree priorities and encourage commissioners to work in an integrated way. The intention is that as a result, patients and the public should experience more joined-up services from the NHS and local councils in the future. Local boards are free to expand their membership to include a wide range of perspectives and expertise, such as representatives from the charity or voluntary sectors.
In addition each local authority will have a local Healthwatch organisation in their area. The aim of local Healthwatch will be to give citizens and communities a stronger voice to influence and challenge how health and social care services are provided within their locality. Local Healthwatch will also provide or signpost people to information to help them make choices about health and care services.
Add to this other bodies such as the NHS Commissioning Board, Public Health England and Healthwatch England to name but a few, and it becomes a complex maze to work oneself through. The intention is the make health and social care more integrated and responsive to the needs of the local community. Support for older people such as that provided by organisations like WRVS has never been more necessary given the constraints on central and local Government spending. It is in everyone’s interest to work towards making sure this new system delivers. Time will tell whether the changes bring about the transformation that is urgently required.