The White Paper: a framework for survival?

Abstract

The re-organisation of the NHS by the new coalition government will, as well as affecting all our lives, attract widespread international interest. Is it possible, in adverse financial circumstances, to sustain an almost wholly state-funded health service, and if so, how? This interest will be sharpened by the inclusion of an ‘outcomes framework’ as one of the central components of the recent government White Paper1 — the Quality and Outcomes Framework (QOF) for general practice has been a subject of intense international attention2 — together with a greatly increased emphasis on the role of GPs in commissioning services for patients. The new NHS Outcomes Framework will be concerned with three ‘domains of quality’: the effectiveness of treatment and its effect on both clinical and patient-reported outcomes; the safety of the treatment provided; and patients' broader experience of health care. Many of the proposals for reform, including pledges to put yet more money into the NHS, are to be underpinned by the ‘release’ of efficiency savings within the NHS (an unprecedented £20 billion by 2014) and an audacious target of cutting NHS management by 45%. The White Paper Equity and Excellence: Liberating the NHS 1 and the supporting Impact Assessment paper, Transparency in Outcomes — a Framework for the NHS ,3 start with an admission that things are not as good as they could be. The ‘amenable’ …