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NHS Reforms

Why does the NHS need updating?
The NHS is a national treasure. But despite the best efforts of staff, the NHS could deliver better care for patients. Right now around one in four cancer patients are only diagnosed when they turn up as emergencies. So although the NHS is good, it could be better still.

What is the purpose of the bill?
To update the NHS to give every patient the best possible health care by trusting family doctors, nurses, and other health experts to work with local people to decide, design and deliver the right health services to meet local need and deliver world class healthcare. The Health and Social Care Bill is designed to give every patient the best chance of surviving an illness like cancer, and the best quality of life if they have a long-term condition like diabetes.

It is basically about more control for patients, greater power for doctors and nurses and less central bureaucracy.

The Coalition’s plans to update the NHS will give patients the best-possible care, on the NHS.
  • When a local hospital feels that they can provide diagnostic tests more conveniently to patients in the community, they will be free to do so.
  • If local GPs see that there is a significant need for physiotherapy services in their local area, they will be able to organise local clinics for their patients – rather than giving them a default option of having to travel to a hospital miles away.
  • When a GP feels that a patient with serious diabetes is in danger of not managing it effectively, they will be able to make sure the patient has the support to remain independent – preventing unnecessary emergency admissions to hospital.
  • When frontline nurses feel that they can deliver better care to autistic children in partnership with a local charity, they will be free to make this happen.
  • When a local community decides that they want a new health clinic or walk-in centre, their local council will be able to work with the local NHS to help achieve this.

Our plans to update the NHS in detail
The power and responsibility for decisions about NHS services will be transferred into the hands of doctors and nurses at the frontline, instead of remote organisations few people have heard of. This means that the NHS’s money will no longer be spent by ‘Primary Care Trusts’. Instead a wider range of experts (clinical commissioning groups) will be given the power and freedom to make decisions about health services for their local community by, for example, including nurses and specialists on the boards of clinical commissioning groups.
  • To prevent political micromanagement, which has damaged patient care, responsibility for overseeing the NHS at the national level will be passed to an independent NHS body – the NHS Commissioning Board. This will stop politicians constantly interfering in the NHS. And we will do away with the top-down targets which do not improve care. We will instead focus on what matters to patients the results and quality of care. This means whether they survive cancer, whether they get seen when they need to be, and whether they are supported to remain in work.
  • To give local communities more power, we will establish health and wellbeing boards in all local councils, with the responsibility of planning local services, jointly with the NHS and social services. These boards will publish a new ‘health and wellbeing strategy’, setting out the ways in which local NHS and social services will be improved in every local area.
  • To give patients more power, we will allow them greater choice anywhere they want which meets NHS standards, so long as the treatment doesn’t cost more than it would do on the NHS. This means that charities and social enterprises will be able to provide services to NHS patients, free of charge, either together with the NHS or on their own. It also means that the private sector will be able to provide NHS services free-of-charge, and we will establish a strong economic regulator to make sure that no-one is behaving unfairly. Any decision about where to be treated will be for the patient himself or herself, in partnership with their doctor, and as now no-one will pay for their NHS care.
  • To help patients and GPs decide where the best services are, we will give everyone more information about the quality of care each hospital and health service delivers. And we will establish a powerful new watchdog – HealthWatch – which will make sure that patients’ views about their local NHS and social services are listened to.

    Changes to the Bill following the ‘pause’:

    Among the key changes announced include:
    • Wider involvement in clinical commissioning groups. A wider range of experts will be given the power and freedom to make decisions about health services for their local community by, for example, including nurses and specialists on the boards of clinical commissioning groups.
    • Stronger safeguards against a market free-for-all. The health care regulator Monitor’s core duty will be to protect and promote patients’ interests, it won’t be required to promote competition as if it were an end in itself.
    • Additional safeguards against privatisation. We will never privatise the NHS, and will create a genuine level playing field to stop private companies ‘cherry-picking’ profitable NHS business. We will ensure that competition is on quality and introduce additional safeguards against price competition.
    • Evolution, not revolution. We will allow clinical commissioning groups to take charge of commissioning when they are ready and able, and a more phased approach to the introduction of Any Quality Provider.
    • Greater information and choice for patients. The Government will make clear that the people who make decisions about local services have a duty to promote patient choice. And following current pilots, the Government will make it a priority to extend personal health budgets including across health and social care.
    • Breaking down barriers within and beyond the NHS. A new duty for clinical commissioning groups to promote joined up services both within the NHS and between health, social care and other local services.
    • Investing for the future of the NHS. We want all providers to make a fair contribution to the costs of education and training of NHS staff, but we will introduce changes carefully and take the time to develop the details right.


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R v SUSSEX JUSTICES ex p McCARTHY [1924] 1 KB 256

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R v SUSSEX JUSTICES ex p McCARTHY [1924] 1 KB 256

November 9 1923

Editor’s comments in bold.

Here, the magistrates’ clerk retired with the bench when they were considering a charge of dangerous driving. The clerk belonged to a firm of solicitors acting in civil proceedings for the other party to the accident. It was entirely irrelevant that there had been no evidence of actual influence brought to bear on the magistrates, and the conviction was duly quashed.

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