- The Bill should place a duty on the NHS Commissioning Board and commissioning consortia to actively promote the NHS Constitution.
- Commissioning consortia should be required to have a governing body that meets in public to ensure transparency in how public money is spent and why decisions are made.
- There must be multi-professional involvement in the design and commissioning of services at every level of the system. Consortia must obtain multi-professional advice to inform commissioning decisions.
- There should be a strong role for clinical and professional networks and multi-specialty clinical senates should be established to provide strategic advice to commissioning consortia, health and wellbeing boards and the NHS Commissioning Board.
- Commissioning consortia should only take on their full range of responsibilities when they have the capacity and capability to do so. Where they are not ready the NHS Commissioning Board should commission on their behalf.
- The Bill should strengthen the role and influence of health and wellbeing boards, giving them stronger powers to require commissioners of NHS and social care services to account if their plans are not in line with the joint health and wellbeing strategy.
- The boundaries of local commissioning consortia should not normally cross those of local authorities, with any departure needing to be clearly justified.
- Experienced managers must be retained to support clinical leaders in tackling financial challenges.
- The NHS Commissioning Board should be given a ‘choice mandate’ to set the parameters for choice and competition in all parts of the service. A Citizen’s Panel (as part of Healthwatch England) should report to parliament on how well the mandate has been implemented.
- Monitor’s role in relation to competition should be significantly diluted – its primary duty to ‘promote’ competition should be removed and the Bill should require Monitor to support choice, collaboration and integration.
- Private providers should not be allowed to ‘cherry pick’ patients and the government should not seek to increase the role of the private sector as an end in itself.
- The NHS should be freed from day-to-day political interference, but the secretary of state should remain ultimately accountable for the NHS.
- Stronger and clearer duties of involving patients in their care should be written into the Bill.
- The NHS Commissioning Board should be established as soon as possible to ensure focused leadership for quality, safety and the financial challenge.
- The Mandate for the NHS Commissioning Board, the outcomes frameworks for the NHS, public health and social care, commissioning plans and other system levers and incentives must all be used to help reduce health inequalities.
- Independent, expert public health advice is needed at every level of the system. At a national level, Public Health England should not be part of the DoH.
- All local authorities, health and social care bodies (including NHS funded providers) must cooperate to improve public health.
- The roles of the postgraduate medical deaneries must be preserved and an interim home within the NHS found urgently.
- The professional development of all staff is not being taken seriously enough and the National Quality Board should urgently examine how the situation can be improved.