Discussion paper in response to the Department of Health (England) white paper on Equity and Excellence (July 2010)

(members only access)

Equity and Excellence summary

The new coalition governement - implications for children's services (June 2010)

The coalition government has made the following commitments which are particularly relevant to children and paediatric services. There are relevant policies from Department of Health, Department for Education, Home Office and Ministry of Justice.

Department of Health in England

This reflects both the coalition policy commitments and the revised NHS Operating Framework for 2010-11.

Structure
• Commitment to stopping 'top-down reorganisations' of the NHS and in particular closure of A&E and maternity wards. Although there is also commitment to reduce duplication and the resources spent on administration.
• Reduction in the number of health quangos.
• Establishment of an independent NHS board to allocate resources and provide commissioning guidelines.
• Abolition of SHAs by 2012.

Funding
• Health spending will increase in real terms in each year of the Parliament, although efficiency savings of £20 billion need to be found by 2014.
• NHS administration spending will be cut by a third and transfer resources to support doctors and nurses on the front line.
• £10 million a year beyond 2011 will be made available from within the DH budget to support children's hospices in their vital work. There will also be a new per-patient funding system for all hospices and providers of palliative care.

Commissioning
• GPs will commission care for patients, with the intention that this will enable them to act as patients' expert guides through the health system. This is likely to be based on clusters of population of ~100k, therefore around 500 GP commissioning groups . GP commissioning will require changes to GP contract and therefore the timescale of implementation is unclear.
• PCTs will commission the residual services that are best undertaken at a wider level, rather than directly by GPs. It will also take responsibility for improving public health for people in their area, working closely with the local authority and other local organisations.

Service Delivery
• There will be financial penalties for emergency readmission of cases within 30 days of discharge.
• Targets will be phased out or revised:
• The four hour A&E target will be reduced to cover 95 per cent of patients with immediate effect with plans to abolish it by 2011.
• The 18 week elective waiting target will be replaced immediately with an average waiting time target with plans to abolish it by 2011. This will require legislation as it is part of the NHS Constitution
• Forty eight hour GP access target will be abolished immediately.
• Urgent care services will be provided 24/7 throughout England, including GP out-of-hours services, and ensure every patient can access a local GP. A single number for every kind of urgent care will be introduced.
• Introduction of a new dentistry contract that will focus on achieving good dental health and increasing access to NHS dentistry, with an additional focus on the oral health of schoolchildren. 

Workforce
• Revalidation to be delayed by a year.
• Initial reports from the coalition indicated that there was commitment to challenging the Working Time Directive; however no detailed policy has been announced.

Quality
• There will be a focus on outcomes rather than targets - such as improving cancer and stroke survival rates or reducing hospital infections.
• Performance of healthcare providers will be published online.
• Commitment to greater involvement of independent and voluntary providers to improve standards of care.

Department for Education (DFE formerly DCSF) in England

• The department will focus on attainment and behaviour within schools.
• DFE has scrapped Contactpoint, although current ideas include a national signposting service for genuinely vulnerable children; this likely to mean fewer children (definition of the cohort is still needed), fewer practitioners accessing and less data for each entry.
• DFE have announced a review of children's social work, to be led by Prof Eileen Monro. The remit of the review will be wide ranging but will be expected to consider what helps or hinders professionals from making the best judgments and interventions they can to protect a vulnerable child. A final report is expected in April 2011.
• The National Safeguarding Delivery Unit will be abolished immediately.  The Safeguarding Group within the Department for Education will retain lead responsibility for the Government's child protection policy and will continue to work closely with other Government Departments, in particular the Department of Health, the Home Office, and the Ministry of Justice.
• The overview report and the executive summary of all new serious case reviews (SCRs) is to be published, unless there are compelling reasons relating to the welfare of any children directly concerned in the case for this not to happen. The Government is also committed to ensuring that the SCR overview reports on the recent high-profile cases in (Baby P, Edlington, Kirklees and Birmingham) will be published.

Home Office in England

• Registration with the vetting and barring scheme has been halted, to allow government review and remodel the process. This remodelling will be coordinated by the Home Office in partnership with DH and DFE; its scope and timescale have yet to be announced.

Ministry of Justice in England and Wales

• This department are now solely responsible for Youth Justice (previously shared with DCSF).
• Have committed to ending administrative detention of asylum seeking children, although clarification is being sought about whether children will be separated from their families, or kept together.