NHS Reforms in England


02 February 2011

The Government's proposals for NHS reform will only succeed if certain conditions are met, including expert GP commissioning of mental health services and service user agreed outcomes.

In its July 2010 paper Equality and Excellence: Liberating the NHS the Government set the NHS in England an extremely challenging agenda of change over the next two years. This includes moving responsibility for commissioning NHS health services, including mental health services, from Primary Care Trusts (PCTs) to GP commissioning consortia and a new NHS Commissioning Board, the development of outcomes-based measures to assess performance and the creation of a new Health Watch body for patients.

The Foundation believes that changes to commissioning responsibilities do have the potential to improve both physical and mental healthcare for people with mental health problems – but only if certain conditions are met. These conditions include:

  • GP commissioning consortia being highly skilled at commissioning effective mental health services for their local population. Currently PCTs spend more on mental health than any other disease category - over £10 billion (compared to heart disease at around £7 billion and cancer at around £5 billion). Consortia management allowances must allow for the hiring of high quality mental health commissioning expertise
  • an acknowledgement that mental health commissioning needs to reflect a social model of recovery, not just clinical care; that 90% of all mental health care is undertaken in primary care; and that there remains inadequate access to effective treatments such as psychological therapies and exercise therapy, and an over-reliance on medication with a level of inappropriate prescribing
  • the implementation of a national tariff for mental health care
  • effective joint commissioning arrangements between GP consortia and local authorities, who will be responsible for reducing inequalities and improving public health.

Mental health is a key public health issue. The Foundation has welcomed the creation of a new Public Health Service with ring-fenced funding arrangements and the proposal that local authorities should have a stronger influence on the health outcomes of their local area. The achievement of best outcomes and quality of life for people with mental health problems requires a multidisciplinary and multiagency approach, involving not just health care but the close involvement of local authority services such as social care, environment planning and housing.

We welcome a stronger voice for users of mental health services and their carers. However if HealthWatch is to achieve this it must be properly resourced to fulfil all its functions and fully represent and engage the interests of ‘hard to reach’ patients who may have difficulty having their voice heard, including some people with mental health problems and their carers (this may require specialist advocacy support).

New mental health outcomes must reflect more than just improvements to clinical symptoms. Important though these are, outcomes need to be holistic, reflecting a person’s whole life and their self-defined goals. This means creating indicators around such issues as employment, income and housing. It will be important for mental health service users and carers must be fully involved in the creation of outcome measures.  

The Government’s commitment to increase health spending in real terms in each year of Parliament is welcome. However, the requirement for the NHS to release up to £20 billion of efficiency savings by 2014 creates a major challenge in terms of protecting existing services and developing new services.


The government set out its proposals to reform the NHS in its paper Equality and Excellence: Liberating the NHS of July 2010.
Equity and excellence: liberating the NHS : Department of Health ...

The paper emphasised the Government’s commitment to give patients more choice and control, helped by easy access to the information they need about the best GPs and hospitals. Shared decision-making will become the norm: no decision about me without me. There will be a strong focus on clinical outcomes.

Specific proposals include:

  • the strengthening of the collective voice of patients and the public through arrangements led by local authorities, and at national level, through a new consumer champion, HealthWatch England, located in the Care Quality Commission.
  • the NHS will be held to account against clinically credible and evidence-based outcome measures, not process targets. Quality standards, developed by NICE, will inform the commissioning of all NHS care and payment systems.
  • the Government will devolve power and responsibility for commissioning services to the healthcare professionals closest to patients: GPs and their practice teams working in consortia.
  • local authorities will promote the joining up of local NHS services, social care and health improvement. Primary Care Trusts and Strategic Health Authorities will be abolished.
  • the establishment of an independent and accountable NHS Commissioning Board. The Board will lead on the achievement of health outcomes, allocate and account for NHS resources, lead on quality improvement and promoting patient involvement and choice.
  • the creation of the largest social enterprise sector in the world by increasing the freedoms of foundation trusts and giving NHS staff the opportunity to have a greater say in the future of their organisations, including as employee-led social enterprises.
  • the ringfencing of the public health budget, allocated to reflect relative population health outcomes, with a new health premium to promote action to reduce health inequalities.

Many of the commitments made in this White Paper require primary legislation and are subject to Parliamentary approval.

February 2010