Published: 29/07/2004, Volume II4, No. 5916 Page 8 9

The Department of Health has announced that 18 of the 38 arm's-length bodies will be abolished following a review which aimed to save£500m and cut over 6,000 jobs.

Announcing the cuts, junior health minister Lord Warner said that although bodies had been set up with good reasons, there was 'some confusion in the minds of people on the front line, including some very senior people, as to what these bodies do.'

He insisted the government had not been 'swinging an axe around in a maniacal way'but had looked at the bodies' functions methodically.

Lord Warner added that although the affected bodies have no right of appeal against the changes, 'what is up for discussion is the detailed arrangement of change, the speed at which it can be done'.

Below HSJ examines the four areas which have been reviewed Standards

What's staying

As well as its current remit of providing patients, the public and health professionals with guidance on best clinical practice, the National Institute for Clinical Excellence will also take on the functions of the Health Development Agency to create a single organisation covering both prevention and treatment of ill health.A centre for excellence in public health will become part of the NICE infrastructure, evaluating public health interventions and weighing their cost effectiveness against that of treatment.

Public welfare

What's staying

The National Patient Safety Agency will continue to work towards improving safety of care and reducing the number of clinical mistakes.

It will take on board the functions of the National Clinical Assessment Authority, which will be established as a separate division within it with its own senior management team and a direct link with the main board.

The NPSA will also take the lead on cleanliness and safe hospital design from NHS Estates.Responsibility for the three national confidential enquiries into suicide and homicide, maternal and child health, and perioperative death will move from NICE to the NPSA and it will lead in supporting the development of ethics committees that review clinical trials and also NHS research ethics committees.

The Health Protection Agency will also take on the functions of the National Biological Standards Board.

What's going

The Commission for Patient and Public Involvement in Health will be abolished.

The report insists that patients' forums will remain the cornerstone of patient and public involvement, promising 'stronger, more efficient arrangements' to provide support and advice.

The best replacement body has yet to be identified.

This will be done in discussion with others, including the Healthcare Commission.

Discussions with stakeholders ahead of legislation are promised.The NHS Appointments Commission will appoint future forum members.


What's staying

The Healthcare Commission stays, but will be able to charge for inspecting independent healthcare providers. It will also take on the remit of the Mental Health Act Commission.

The Independent Regulator of NHS Foundation Trusts will be formally established as a non-ministerial government department.

A review of the Commission for Social Care Inspection's charging system will decide whether it should charge for the full cost of inspection.Although the 'direction of travel' is towards merger with the Healthcare Commission, the report says it would now be a distraction for both organisations.

The Medicines and Healthcare Regulatory Agency will continue, as will the Council for the Regulation of Health Care Professionals and the General Social Care Council.

What's new

The Regulatory Authority for Fertility and Tissue will be responsible for the regulation and inspection of all human tissue functions.

It will replace the abolished Human Fertilisation and Embryology Authority and the Human Tissue Authority.

Central services to the NHS What's staying Legislation will be pursued so the NHS Appointments Commission could make appointments to other bodies, including nonNHS ones.Responsibility for appointing patients' forum members will transfer to the commission.

The National Programme for IT will become a time-limited executive agency for three to five years and will incorporate the IT infrastructure of the NHS Information Authority, which will be abolished.

The NHS Litigation Authority will be reconstituted to oversee the NHS redress scheme and manage financial compensation.

It will also take over the functions of the Family Health Services Appeal Authority (special health authority).

What's changing

The NHS Purchasing And Supply Agency will be reshaped as part of a major programme being developed by the DoH's commercial directorate.The report says the PASA should be able to take on procurement and contracting functions from other arm's-length bodies.

The commercial directorate will markettest the work of the NHS Logistics Authority to decide whether its function should be contracted out What's new The Blood and Transplant Authority will be the result of a merger of the National Blood Authority and UK Transplant.The work of the new body will be reviewed to examine the scope for more efficient operation. In future the new organisation might be made some kind of public benefit organisation.The Regulatory Authority for Fertility and Tissue may take over the regulatory functions of the BTA.

The Health and Social Care Information Centre will combine the information-related functions of the NHS Information Authority and the statistics and information management functions of the DoH. It will co ordinate information requirements across a wide range of bodies.

NHS Business Services Authority will merge the functions of the NHS Pensions Agency, Prescription Pricing Authority, Dental Practice Board and the NHS Counter Fraud and Security Management Service.A review under way of the business processes of a number of arm's-length bodies will influence the approach and functions of this new body.

The review is expected to clarify the scope of the new organisation and the opportunities across a number of bodies in which backoffice and other functions might be suitable for transformation.

What's going

The trading arm of NHS Estates, Inventures, will be disposed of.

What's being slimmed down

The Modernisation Agency will have about 150 posts undertaking diagnostic analysis and the design of new improvement programmes. Its future operational form is yet to be decided What's changing NHSU is currently subject to a more detailed study, which will be completed shortly.

NHS Direct will retain its arm's-length status for two to three years but will prepare itself for transfer to independent status as a body established on foundation principles to operate in the public interest.

NHS Professionals will also prepare to take on a similar status over the same time scale, and should be self financing by 2007-08.