Brown talks to HSJ about his preventive healthcare vision

In his first major speech on health policy, Gordon Brown spelt out his intention to recast the NHS as a preventive and personal health service. There will be a stronger role for commissioners and more screening to enable earlier detection and prevention of illness.

Mr Brown said he wanted patients to be “partners” with more power, choice and control over their care.

As part of this vision he wanted to see 3 million foundation trust members by 2012 - up from 1 million at present. He also envisaged foundations taking over failing hospitals and moving into the provision of primary care.

“To drive up performance we will not just increase the freedoms and autonomy of our local NHS - giving hospital clinicians and GPs stronger incentives to work together and allowing foundation trusts the freedom to provide primary care services where this is in the interests of patients - but we will also increase accountability of local services to local people,” he told an audience of health professionals at King’s College in London.

Foundation Trust Network director Sue Slipman told HSJtrusts had been “hugely keen” to move into primary care provision for some time. “It’s a green light to foundation trust boards that it’s now worth investing in these sorts of services,” she said.

University College London Hospitals foundation trust chief executive Sir Robert Naylor said that as a result of the announcement the trust would consider whether it would provide the primary care services in its planned polyclinic itself, rather than invite a group of GPs or a private sector provider.

Monitor executive chair Bill Moyes said it was “perfectly possible” that foundation trusts would have 3 million members in four years’ time as more trusts became foundations.

He said this would lead to greater differences between trusts. “It is important for the government to recognise that people are only going to be members of trusts if they are allowed to influence the way hospitals function,” he said.

But foundation trusts are not keen to be coerced into taking over failing hospitals unless there is a strategic benefit and little or no financial risk.

Mr Brown gave primary care trusts a boost, too, saying they would be at the vanguard of the move towards a more preventive service.

He also reassured the private sector of its continued role. Primary care providers should form partnerships with the private and voluntary sectors and acute care would continue to be opened up to private provision.

“There will be no ‘no-go areas’ for reform as we seek to deliver the preventive and personal services which will renew and secure the health service in the future,” he said.

The prime minister pledged more decisive action against failing services, promising the removal of “underperforming hospital management”.

HSJ understands the Department of Health expects to publish a new failure regime this year. This would give strategic health authorities a more active role in turning around underperforming organisations, for example by scrapping boards and managing competitive bidding by foundation trusts to take over failing services. On the primary care side the government wants it to be easier for commissioners to replace failing GP services.

Brown’s promises

• Focus on prevention as well as cure

• Greater access to primary care

• Screening for vulnerability to heart and circulation illnesses

• Choice and information for patients to take a more active role in their care

• Patients’ prospectus with options for 15 million people with long-term conditions to receive care at home

• “Active patient” programmes

• Three million foundation trust members by 2012

• Greater local devolution and accountability

• Decisive action against failing services

• Seamless integration of primary and secondary care

• NHS constitution enshrining patients’ rights and responsibilities

• Consideration of personal healthcare budgets

• Employers to help staff be healthier

• No moratorium on change

Gordon Brown spoke to HSJ about how managers should implement his plans for preventive, personal healthcare

The shift to prevention

“It’s going to be locally delivered more than nationally prescribed so managers themselves will be directly involved in making this possible at a local level. The national screening that we are committing ourselves to will start this year but it will be phased in over a period of time and I think what happens at a local level, where some can move more quickly than others, is going to be very important.”

Patients as ‘partners’ rather than consumers

“The best management is empowering the patient and we’ve already got these expert patient programmes that are working well. We’ve already got a far wider flow of information than ever before to the population and to local patients and I think again this is what in the end both patients and health service professionals want. They want a better relationship of trust based on empowering the patient, giving the patient more information and education, and then the patient in this position [can] do more about their own health.”

Three million foundation trust members by 2012

“I think the more that patients are involved in their own care, the more they will want to be at least consulted and involved in the trusts themselves. I think local accountability grows the more information there is flowing to the patients. And if in some hospitals certain things are done faster than others, people will ask questions; if in certain hospitals things are done more expensively than others, people will ask questions.”

Primary care trusts

“They’ve got the big role to play, because a lot of what I said this morning is about commissioning services. This policy-led agenda is one that they as commissioners could lead in putting into practice.”

PCT accountability

“This is an issue that we’ve got to keep listening to what people say and it’s something that over the course of the year when we look at the NHS constitution, we can listen to what people are saying about this.”

Prospect of individual healthcare budgets

“You are talking about the social services side where there are personal care budgets and large numbers of people are able to manage their own care by making their own decisions about budgets given to them. There are opportunities in some aspects of healthcare, but only where appropriate, I think, for there to be these personal care budgets as well. So that’s what we’ll look at over the course of the next year.”

The verdict

Chris Ham, professor of health policy and management, Birmingham University

“It was a thoughtful, reflective, wide-ranging tour of the horizon of healthcare. He made some welcome points on the changing pattern of disease. The risk is that more resources will get sucked into acute hospitals under payment by results.”

Julian Le Grand, professor of social policy, London School of Economics, and Health England chair

“There’s a question of how you construct appropriate incentive schemes for commissioners. If a commissioner is faced with a choice of bailing out the local acute trust or engaging in a preventive programme which is not going to pay out for 20 years, which are they going to do?”

Richard Lewis, director of health, Ernst & Young

“It was an interesting and careful repositioning of health policy but with a pretty clear signal that there’s going to be no turning back from the fundamentals of NHS reform.”

David Stout, director, PCT Network

“There was a welcome emphasis on commissioning in line with the world class commissioning work that’s been ongoing for the last few months.”

Niall Dickson, chief executive, King’s Fund

“The prime minister is right - if we want a health service that is sustainable it will need to do more to keep people as healthy as possible as well as treating them when they are sick. It is not a question of one or the other - a modern service has to do both.”

Andrew Lansley, shadow health secretary

“There is no proper timetable for delivery; we don’t know where the money’s coming from but we do know Brown has raided public health budgets.”

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