Government plans to transform the health service moved on with a new health bill and the publication of the much-vaunted NHS Constitution.
The legislation promised direct payments to patients with long-term conditions to allow them more control over the care they receive. Trials will begin next year on three types of personal healthcare budget.
Such a system was unlikely to be straightforward, said the King's Fund, a health thinktank. "Getting the initial payment level right will be important as will deciding what restrictions to place on the kind of treatment a patient is allowed to purchase with tax payers' money and from whom," said chief executive Niall Dickson. The health bill also requires NHS organisations to publish annual "quality accounts", introduces prizes for innovation, and strengthens the health secretary's powers to suspend NHS leaders and appoint special administrators to oversee failing trusts.
The NHS Constitution represents the first time the values of the health service have been enshrined in a legally-binding document. Health secretary Alan Johnson said the document, which sets out rights and responsibilities for both staff and health service users, would make the NHS more accountable and protect principles such as free treatment. But some patients' groups fear it will make little difference to everyday care. The health bill requires NHS organisations to "have regard to the NHS Constitution" but it is unclear what that will mean in practice. New rights for patients to choose their GP practice and specific doctors could have repercussions for practices and Primary Care Trusts (PCTs), warned the NHS Confederation, which said appropriate funding and staff levels must be in place to make it work.
In their first report on the government's wide-ranging Next Stage Review of the NHS, MPs on the health select committee questioned whether primary care trusts (PCTs) were up to the task of implementing the reform plan, which involves basing more health services in the community. PCT commissioning was too often poor, PCTs lacked analytical and planning skills and there was variable quality in management, concluded the committee, which doubted whether the government's World Class Commissioning programme would fully address these issues.
Children's services and child protection policies can expect close scrutiny in the coming year. Last month it emerged the Department for Children, Schools and Families had ordered a "thorough diagnostic review" of children's services in Doncaster, where serious case reviews into the deaths of seven children have been completed or are under way. The authority was one of four rated inadequate for children's services by Ofsted in December, when the government announced it was sending intervention teams into nine councils. Ministers will be under pressure to prove the efficacy of reforms to improve child protection in the light of these inquiries and the recent Baby P case in London's Haringey.
It was the appalling death of Victoria Climbié - another child known to Haringey social services - in 2000 that led to legislation in 2004 and the launch of the Every Child Matters agenda, designed to promote better joint-working between professionals and earlier identification of children at risk.
A three-year strategy has been launched to improve the lives of people with learning disabilities across health, housing, employment and social care. It includes the establishment of a national Learning Disability Programme Board. Regional boards will report to the national board and oversee local partnership work. The health department also announced a confidential inquiry to examine why people with serious learning difficulties have died under NHS care.
Other developments in social care include proposals to streamline assessments for adults who need health and social care services. The Common Assessment Framework for Adults is designed to help professionals share information and avoid families having to repeat their stories. A similar process is already being used in children's services.
