The white paper was accompanied by the following documents:
- Department of Health draft structural reform plan
- analytical strategy for the white paper
- letter from Sir David Nicholson, sent to all chief executives on 13 July, which set out how the transition will be managed.
Further consultation is planned in a range of key areas including the operation of workforce planning and education and training. More detail is also expected on pay arrangements.
Draft legislation is expected to enter Parliament in the Autumn, following the consultation. However, there are actions that the NHS is expected to begin now in preparation for the changes.
Efficiency
The white paper reiterates the continuing drive for efficiency savings of up to £20 billion, which includes a 45 per cent reduction in management costs. NHS organisations are expected to achieve these through the quality, innovation, productivity and prevention (QIPP) programme.
Staffing
The NHS will employ fewer staff by 2014 although the white paper does also say that frontline staff will be protected. The abolition of SHAs and PCTs will affect staff employed in these organisations and lead to redundancies. However, the scale of job losses is hard to estimate at this stage.
Transfer of the PCT commissioning role to GP consortia will have a major impact on staff employed in commissioning roles in PCTs. It is expected that some of these staff will transfer to other organisations and arrangements will need to be in place to support this. It is not clear yet how the GP commissioning responsibilities will be implemented with the current GP contract.
In his letter to chief executives, David Nicholson recognised that there is “significant uncertainty about how many jobs, of what type and in what organisations”. He promised that the NHS would work with staff and staff-side organisations to shape the new world and the process for deciding their future, with consultations expected to take place at a local level.
He has asked chief executives to ensure that all staff who will be affected by the changes have an opportunity to speak to their line managers about how they will be affected by the end of September 2010.
There will be a drive to enable all providers to become foundation trusts and the white paper stated that the foundation trust model will be reviewed with a view to developing more “employee-led” organisations. At this stage there is no further detail and consultation is expected later in 2010.
The shift to a policy of Any Willing Provider and encouragement of social enterprise is likely to mean more transfers of existing staff to non-NHS providers and more diversity in the employers in the NHS. This may raise issues with the current framework for the transfer of staff under the Staff Passport and with membership of the NHS Pension Scheme.
In his letter to the chief executive community, David Nicholson sets out plans to lead the implementation of the white paper. These include proposals to ensure that wide-ranging engagement is at the heart of the transition, building understanding of, and support for, the change process.
Pay
The white paper reiterates the statement in the Budget that the NHS will be included in a two-year public sector pay freeze from 2011/12. The pay review bodies will be asked to make recommendations on pay for staff earning under £21,000. In the medium term, the Government wishes to see employers lead negotiations for any new employment contracts. This opens the way for local employment terms and conditions but it is not clear at this stage how this model will run alongside the national pay machinery and how quickly it will develop. Many employers will want to continue to use national contracts as a basis for their local terms and conditions.
The Government will consider the findings of an independent review of public pensions, chaired by Lord John Hutton, later this year. However, the white paper outlines a commitment to ensuring that pension solutions are found that are fair to the workforce in the health service and fair to the taxpayer.
The review is expected to look at the affordability and sustainability of public service pensions and also consider issues such as access, the impact on labour market mobility between the public and private sectors, and the extent to which pensions may act as a barrier to greater plurality of provision of public services. An interim report will be produced in September 2010 considering the case for short-term savings within the comprehensive spending review period.
The white paper also makes announcements on future arrangements for education commissioning and workforce planning and further consultation is planned on this. Education commissioning will be led locally and nationally by the healthcare professions, with organisations like Medical Education England expected to take a key role. There is also a greater role for employers working with staff at a local level, with national support from the Centre for Workforce Intelligence.
Education funding arrangements will be reformed with the NHS Commissioning Board providing national oversight of healthcare providers' funding plans for training and education and GP consortia providing this oversight at a local level. It is promised that changes will be fairer and implementation will not destabilise current providers.
The Government is consulting on the white paper between now and 11 October 2010 and is initally seeking views on the following areas.
- NHS outcomes framework: a new framework to establish improving quality and healthcare outcomes as the primary purpose of all NHS-funded care.Transparency in outcomes: a framework for the NHS (published 19 July).
- Commissioning for patients: how the new system of GP consortia and the NHS Commissioning Board will work in practice. Commissioning for Patients (published 22 July).
- Increasing democratic legitimacy: strengthening local partnerships between NHS commissioners and local authorities. Local Democratic Legitimacy in Health (published 22 July)
- Freeing providers and economic regulation: how best to give real freedoms to hospitals and community services and a new system of regulation. Regulating healthcare providers (published 26 July)
Publications on the future of education and training and an information strategy are expected in the Autumn.
NHS Employers will be submitting a joint response with the NHS Confederation. See our health white paper page for consultation details. Updates and calls for employer input will be published in the weekly NHS Workforce bulletin.
Arm's-length bodies review
The Government has also announced proposed changes to the arm's-length bodies supporting the NHS. (Report of the arm's-length bodies review, published 26 July).
The report sets out the Government's strategy and announces the new configuration of the sector. Some of the changes include:
- moving the Health Protection Agency and the National Treatment Agency to the new Public Health Service
- abolishing the Appointments Commission, the National Patient Safety Agency and the NHS Institute for Innovation and Improvement
- changing the Council for Health and Regulatory Excellence to operate on a full-cost recovery basis.
The Department of Health intends to "engage on these proposals with the arm's-length bodies and other interested parties" and will introduce bills to Partliament this autumn for the necessary legislative changes.
Key dates for employers
The Department of Health has published the Government’s proposed timetable (subject to Parliamentary approval for legislation). The following key dates will be of particular relevance to employers.
- All staff affected by SHA and PCT abolition to have had a discussion with their line managers – by end of September 2010.
- Separation of SHA’s commissioning and provider oversight functions – by end of 2010.
- Public health white paper published – late 2010.
- GP consortia established in shadow form – 2011/12.
- Majority of reforms come into effect – April 2012.
- Formal establishment of all GP consortia – 2012.
- SHAs are abolished – 2012/13.
- PCTs are abolished – from April 2013.
- All trusts become, or are part of, foundation trusts – 2013/14.
- NHS management costs reduced by over 45 per cent – by end of 2014.
See the Department of Health’s provisional overall timetable.
Our health white paper section has the latest news, updates and resources related to the white paper.
The white paper and related documents are available on the Department of Health website: www.dh.gov.uk/liberatingthenhs.
For NHS Confederation summaries and analysis of the white paper, including an interactive timetable and perspectives from the NHS Confederation networks, see the NHS Confederation white paper web section.