Exclusive: government to publish second command paper
The government is planning to publish a second NHS policy “command paper” as it attempts to rescue its floundering Health Bill, HSJ has learned.
Senior Whitehall sources said the document – likely to come within a month – will attempt to explain the coalition’s new agreed position on NHS reform.
It will seek to sell the new proposals before amendments to the Health Bill are tabled, in the style of the “command paper” published by the Department of Health in December ahead of the initial legislation. It is being described as the “command paper mark II”. It is expected to respond to recommendations made by the NHS Future Forum review.
Senior sources said the key component of the government’s attempt to rescue the bill will be to promote integration of services – in contrast to what has been seen as a focus on competition.
The government is likely to encourage primary care-led commissioning consortia to work closely with local networks of other clinicians to integrate provision and ultimately potentially creating new provider organisations. Previously the focus has been on consortia as commissioners distinct from providers. The government may also highlight hospital trusts which are integrating with community services, having taken them on from primary care trusts.
It is planning to describe how these approaches, if they are shown to work, could be pushed more widely by Monitor under its new duties. It will significantly change Monitor’s role in practice, away from being a “proactive” economic regulator.
One senior source said there would be “a framework where people can start bottom up to create integrated care”. The source said: “The government will say very strongly that integrated care is a really good thing and you should support it as best you can, and roll it out.
“We will start to get a model emerging where consortia and others work together more directly as providers.”
The government is believed to see the plan as a key part of convincing opponents to the Health Bill. A source said ministers believed they were, “moving towards a settlement in a way the NHS will say, ‘That’s reasonable’”.
A DH source said it intended to respond to the Future Forum report quickly. It is understood the DH hopes this can happen by the end of next month.
A DH spokeswoman said in a statement: “Any speculation about the government’s response to the NHS Future Forum’s report is premature. We await their report which is due next month.”