Engaging with Emerging Health Structures

Dr Peter von Eichstorff City Locality Lead Oxfordshire Clinical Commissioning Group

A system focused on improving outcomes Economic regulation and quality inspection Enhanced local voice Clinically-led commissioning & payment by results Empowered professionals working in autonomous providers Informed patients exercising choice

Summary of NHS reforms

Parliament Funding Accountability Reformed NHS Department of Health NHS Commissioning Board

contract

Monitor (economic regulator)

licensing

Care Quality Commission Local Authorities

local partnership

GP Commissioning Consortia Local Health Watch

accountability for results

Patients and Public Providers

Finance: How much are we funded in Oxfordshire to provide all the health care for one person for one year ?

£1300

(per patient)

to provide:

• • • • • • GP services Community health services Mental health services All drugs/medicines provided All hospital services All NHS dentistry Hip replacement £5500 Heart Bypass £7400

£1300

per Patient • • • • 7 th lowest in Country out of 154 PCTs Lowest 5% funding This applies to all hospital departments All providers..

The Nicholson Challenge

• • • Take 4% per year out of secondary care 20% over 5 years £200 million locally

The Good News

• • • • • £200 million reinvested more effectively In primary care Community care Voluntary Third Sector Private Sector

The Bad News

• • • Debts £20 million+ predicted Primary Care, Dentistry, Public Health make yearly surpluses These budgets move to National Commissioning Board

Summary

• • • We have never needed voluntary sector more There has never been less money There has never been more opportunity for the voluntary sector to contribute

Difficult Planning A huge number of voluntary organisations are currently delivering health related outcomes that are funded from within the health system – mainly through PCTs.

Many of these organisations are looking to deliver more services but are currently struggling to come to terms with what clinical commissioning will mean for them.

Planning in the sector is proving incredibly difficult in the current environment with so many uncertainties and organisations are struggling to make sense of how clinical commissioning will evolve.

Emerging Themes

New landscape is confusing for voluntary sector and we

might lose really valuable assets if we’re not careful – NHS and DH need to help voluntary sector interpret new landscape and make sense of it

GPs don’t necessarily understand distinct contribution

of voluntary sector – hearts and minds awareness raising needed based on GP reality, not moral high ground

How might voluntary organisations work together and with other sectors to make themselves easier to commission

Any Qualified Provider

EU law Level playing field – out to tender Complexity requires certain size

Any Qualified Provider

How will the Government make sure smaller providers are not disadvantaged?

Any Qualified Provider

• Smaller providers, including charities, social enterprises and other not for profit and for profit organisations are central to our vision for Any Qualified Provider.

Any Qualified Provider

• The standards to be an Any Qualified Provider will be proportionate and appropriate to the market for a particular service. … • we know that there is considerable interest amongst smaller providers in offering their services through patient choice of provider – • our process is simpler for all providers and as such should be more accessible for smaller providers.

Any Qualified Provider

• Smaller providers (both not for profit and for profit) often better understand the needs of their local population and can deliver specialised, tailored and innovative service models. This means they should be well placed to secure patients under Any Qualified Provider.

What is a LINk?

L ocal I nvolvement N etwor k LINk

A short history of “The independent patient voice”

1974 2003 2008 2012……?

Community Health Councils PPI forums LINks Health Watch

Who is the LINk?

                 Patients Faith Groups Older People Frontline staff Tenants' Groups Community Groups User groups Black and minority ethnic communities Carers' networks Patient groups Patient Participation Groups Individuals Voluntary Groups Rural communities Neighbourhood groups Children's groups Transitory populations ….. etc….

“A network of networks”

The future: Local HealthWatch

Clinical Commissioning Consortia Local HealthWatch Health & Wellbeing Boards PPGs Voluntary / user-led groups Carers’ groups Third Sector Patients

Local HealthWatch will :

Build on existing LINk functions :

 Be volunteer-led  Gather views of local people  Identifying problems and gaps in services  Work with third sector, volunteer and user led organisations

How Can You Help

• • • • • • • Encourage your members to use service responsibly Encourage self care Manage expectations Representation Avoid duplication Combine resources Measure outcomes

How Can You Help

• • • • • Identifying need Feeding into HWB board Devising the JSNA Remembering JSNA priorities – inequalities… Deprivation / Ethnicity and many more

How Can You Help

• • • • • • • Identify waste Move from secondary care Eg Redesign patient pathways Avoid admissions Treatment at home Planning in advance Bid for contracts

Summary

• • • • • • There is no more money There are opportunities The NHS is shrinking The other sectors must expand But we need to prevent fragmentation We need to work together

Summary

• • • • • There is no more money There are opportunities The NHS is shrinking The other sectors must expand We need to work together

Summary

• • • • • There is no more money There are opportunities The NHS is shrinking The other sectors must expand We need to work together