Review: Equity and Excellence: Liberating the NHS

The DOH White Paper ‘Equity and Excellence: Liberating the NHS’ is reviewed here. The paper is available here. White papers can be quite complex and difficult to summarise concisely commenting as they do on the structure and function of the NHS which itself is complex. Therefore I won’t attempt to summarise it concisely but will instead refer the interested reader to the link above.

Firstly I interpreted ‘liberating the NHS’ to mean that there would be a move away from central control to the decentralised management of the NHS by frontline services. Moving on from there, the document is divided into the following sections

  • Liberating the NHS
  • Putting Patients and Public First
  • Improving healthcare outcomes
  • Autonomy, accountability and democratic legitimacy
  • Cutting bureaucracy and improving efficiency
  • Conclusion: Making it happen

There is a lot to take in from reading this document and I suspect it would take on slightly different meaning on each subsequent reading (e.g noticing some parts of the document that might have been missed on previous reading, or else the reader integrating parts of the document with recently acquired information). I found a number of points of interest….

There is an emphasis on the patient being involved in the decision making process about their treatment summarised with the caption

No decision about me without me

The principal of involving patients in the decision making process isn’t new but the white paper expands on some of the details of how this can be achieved and highlights a role for a newly formed NHS Commissioning Board in supporting this principal. There is a move away from measuring processes and instead focusing on individually tailored outcome measures. An information revolution is promised. There is mention of a pending Health Bill and the formation of Health Watch organisations that will provide a check on health service delivery at the local authority level. Another body – Monitor is introduced with multiple functions. There is a neat diagram – figure 2 on page 39 which summarises some of the complex relationships between the various organisations. Increasing productivity and quality in the context of marked financial constraints is emphasised as well as a role for external agencies. The paper also includes a detailed timetable of events.

The document provides a blueprint for the NHS and builds upon previous areas, contains encouraging innovations and takes a different direction in other areas. The timetable is clearly outlined and it will be interesting to see how this develops at each point.

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