Summary and comment on Our Health, Our Care, Our Say White Paper

(Published February 2006)

Introduction
The White Paper, Our Health, Our Care, Our Say, published on Monday 30th January covers a range of initiatives designed to shift the balance of services from secondary to primary care.

Key points
The document contains several key initiatives and issues which are highlighted below. Mike Sobanja, NHS Alliance Chief Executive and a Director of Health Direction Ltd provides a concise and pertinent comment at the end of the summary.

Shifting expenditure from spending on hospitals to spending on care closer to home and on preventative services

• developing a new Expanding Practice Allowance to incentivise further development of practices in under-doctored areas
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  further guidance on the development and support for Practice Based Commissioning
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  a timetable for the delivery of more outpatients appointments in primary care, initially targeting key specialities e.g. dermatology, ENT, trauma and orthopaedics, urology, gynaecology and general surgery using demonstration sites to define models of delivery
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  extending patient transport to enable this to be used for outpatient appointments in primary care
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  performance management to measure the degree of shift from secondary to primary care providers
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  patients to be allowed to register with practices near to their workplace or home, although only one registration will still be allowed
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  increased opening times to meet the needs of patients in line with the findings of the recent public consultation e.g. out of hours, extended opening hours
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  an improved role for community hospitals as points of access
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  Infrastructure to support these changes
  
• national procurement support for those PCTs dealing with recruitment of alternative providers where this cannot be resolved locally
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  further work on delivering a balanced score care approach with a review of Payment by Results
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  work on the unbundling of tariff to support the development of different care
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  packages across health, social care and voluntary and community sector providers
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  a Social Enterprise Unit to support the development of social enterprise models of provision
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  a review of the agreement with NICE
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  New responsibilites placed on local councils and the NHS to work together
  
• further development of Local Area Agreements as a mechanism for strengthening partnerships
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  integration of health and social care planning cycles to ensure joined up approaches to local planning
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  an emphasis on well-being and joint working, including joint health and social care plans for people with long term conditions and joint local networks
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  a single complaints procedure across health and social care
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  a national framework for NHS continuing care assessments
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  further guidance on the role of the Director of Adult Social Services, emphasising working in local health and social care partnerships
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  a strengthening of the Director of Public Health role linking more closely with Overview and Scrutiny Committees in Local Authorities on local health needs
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  national criteria on the means testing of services and a commitment to extend personalised budgets and direct payments
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  New services and developments for existing services
  
• a new service, NHS Life Check to assess people’s lifestyle risks and target interventions and advice accordingly
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  expansion of the Expert Patient Programme with a trebling of investment and the development of community interest companies to deliver local models
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  the development of an “information prescription” for people with long term conditions
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  development of an Expert Carers’ Programme to support the carers of people with long term conditions
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  more support of carers through improved emergency respite and a national helpline
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  a Urgent Care Strategy to improve access to emergency care particularly in the community
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  improvements in End of Life Care
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  rapid access to sexual health services
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  a new screening programme for bowel cancer
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  more choice for women in maternity care
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  better follow up for ex offenders with mental health and lifestyle problems
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  a commitment to close campus based provision for adults with learning disabilities
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  improved access to child and adolescent mental health services (CAMHS) nationally
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  pilot schemes for direct access to some services delivered by allied health professionals

Comment from Michael Sobanja

For over two decades, Governments have subscribed to a “Primary Care Led NHS” – there now seems real potential that this may become a reality. International research (WHO and Starfield amongst others) demonstrates that strong primary care produces at least as good outcomes at least cost.

Having said that, there is really very little new in the White Paper that has not been contained in policy for some time now. Shifting the balance of power always had three elements – from the centre to the front line; from secondary to primary care; and from professional to patient. The legitimisation of private providers as part of the NHS family has important consequences. If the politicians can hold their nerve, there will be a reduction of acute beds and more expansion in community and primary care – the customer base is changing…

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