Lansley outlines NHS 'revolution'

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The health secetary has appeared before a committee of MPs to explain his plans for the NHS.

Stephen Dorrell, the chair of the Commons health select commitee, said that the coalition government's white paper, unveiled last week, is the largest re-organisation of the service in its 60-year history.

Health secretary Andrew Lansley said he wants to hand over commissioning power to hundreds of GP consortia in place of the current primary care group-led structure.

He said the government's plans would put patients "at the heart of NHS" and "empower patients" with information, control, choice of GP, and choice of services.

Lansley said all patients are entitled to "no decisions about me without me" and there will be a focus on outcomes.

"The purpose of NHS is to ensure patients have access to treatments as good as anywhere in world," he said, so it is right to measure outcomes.

Professional empowerment is another key part of public reform, the health secretary told the committee.

While it was not Tory policy before the election to abolish PCTs, "when we looked at the functions, there needed to be genuine accountability, not instructions from Whitehall," he said.

Ministers will remain accountable for the level of resources and the framework the NHS works in, but not in trying to prescribe in detail how it is to be done.

The government wants to "create local relationships between professionals and a local strategy for health and social care".

There will be no upheaval in local services, Lansley claimed.

There will instead be "a substantial reduction in management costs, starting this year and rising to 45 per cent cuts in management".

While GPs will be leading consortia locally, the strategic focus will be with local authorities.

Lansley said this "de-layering" will reduce costs.

"Locality-based commissioning will not be run from the top down and must focus on patients, be clinically-led and be responsible locally for results," he said.

Andrew George (Lib Dem, St Ives) said that PCTs provide local democratic accountability.

"Where is the local community in these new plans, the genuine empowering of local communities to defend their local services?" he asked.

Lansley said in the coalition agreement there was a presumption there would be elections to PCT boards, "but when you examine that structure, it seemed better to dismantle it".

Local authorities have statutory powers in relation to health and he intends to strengthen them.

A strategic role for local authorities is "the most significant statement" in the white paper, Lansley said.

If the consortia and the local authority cannot agree, an independent reconfiguration panel and secretary of state can intervene.

Fiona Mactaggart (Lab, Slough) asked if the headquarters of the NHS is now the GP's surgery.

She asked what guidance doctors would get to help them make informed decisions on commissioning.

Lansley said: "At the moment the NHS is whatever the secretary of state thinks it should be."

He said his plans would not be a "100 per cent decentralisation" as resources will be allocated through the NHS commissioning board.

The process of peer review for GPs will hold practices to account, he said.

Graeme Morris (Lab, Easington) said the pace of change has been described as the biggest privatisation in history. He asked if it is not prudent to move more slowly and raised the worry that there will be fragmentation of specialist provision.

Lansley said a "body of evidence" makes clear that practice-based commissioning consortia will work and there will be a two-year transition to the new structure.

Rather than the health department deciding on what treatments can be afforded, local doctors should decide their view on efficacy of various treatments.

NICE will not mandate but give people access to evidence, he said.

Most commissioning in practice happens in GP surgeries and under the new system responsibility for incurring expenditure, management of care and resources will happen in the same place.

However, GPs may be compelled to join a consortium.

"If we are to have the scope of commissioning there must be unanimity," Lansley said.

Dr Sarah Woolaston (Con, Totnes) asked if GP time spent on commissioning will be a management cost or paid for out of their clincical time.

Lansley said GPs are contracted for primary medical services, separate from commissioning responsibilities, for which they will be paid a commissioning fee.

The management cost of PCTs is £1.5bn per annum or £45,000 per GP.

Lansley said he is going to reduce that down to £1bn in three years, meaning a lot of money to pay for management support for GPs.

Rosie Cooper (Lab, West Lancashire) asked if consortium meetings would be held in public.

Lansley said the principle he will be applying is to avoid "proscribing how they do their business".

Asked about the foods standards agency, Lansley confirmed that it will not be abolished.

The health secretary was also asked about social care, the impact of the spending review and the social care commission.