Transcript Hospitals in London

Liberating the NHS?
Overview of the new NHS and the opportunities for
older deaf and disabled Londoners to have their say
Age UK London & Inclusion London
7th February 2013
Michael Bell, Director of MBARC,
Associate Director of NHS London & Chairman Croydon
Health Services NHS Trust
Presentation Outline
• Financial Challenge
• Overview of the new NHS Architecture
• A New Commissioning Landscape:
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NHS Commissioning Board
Clinical Commissioning Groups
Commissioning Support Services
Primary and specialised commissioning
Public Health
• A Changing Provider Landscape and Any Qualified Provider
• Opportunities for older deaf and disabled Londoners to have
their say
How did we get here…
and where are we going?
Whoever wishes to foresee the future must
consult the past. Machiavelli
History consists of a series of accumulated
imaginative inventions. Voltaire
... Not quite what we expected...
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Health Care before 1945
Original NHS Budget
Growing Needs
Medical Advances &
Changing Expectations
• “Matron Knows Best”
Culture
• Vested interests....
Facing the Big Squeeze:
The £20bn “Nicholson” Challenge
A Growing Funding Gap
£20
£111
2015
£131
2014
£126
2013
£122
2012
£118
2011
£114
2010
£110
Funding Requirement
£16
£110
£12
£110
£110
£110
£110
£8
£4
£-
Funding Allocation
Funding Gap
A Return to Growth?
• Average Increase in NHS expenditure 1949-2010 –
4% above inflation p.a.
• 2011-2015 increase in expenditure 0.1%
• The tightest spending round in 50 years
• Demographic pressures leading to increased
demands on NHS services
• A return to 4% annual growth rate unlikely – it would
require a further seven year freeze on all other public
expenditure or a substantial rise in taxes or debt
NHS & Social Care Funding: The Outlook to 2021/22 (Institute of Fiscal Studies)
The health and social care landscape will look very different from April 2013
Health & Wellbeing
Boards (HWBs)
‘Footprint’ / Local
Parliament
Version 0.4
Sector
National
Funding
Accountability
Other
Local Authorities
(incl. Public Health)
Public Health
England
DH
Health
Education
England
NHS
Commissioning
Board
NHS Trust
Development
Authority
London
Health
Education
NHS CB
London Sector
NHS TDA
London Sector
Clinical
Senates
NHS CB
Patch Teams
Commissioning
Support
Services
contract
contract
Clinical
Commissioning
Groups (CCGs)
Monitor
Joint licensing between
Monitor and CQC
Work together
to ensure
commissioner
support for
aspirant FTs
contract
NHS Trusts
FTs
Providers
Accountability for results
Local HealthWatch
CQC
(economic
regulator)
Patients and Public
NHS CB Sectors – North,
Midlands and East, South and
London
27 local offices of NHS CB
Summary of functions
Summary of functions
• Managing the Board’s day-to-day
relations with CCGs, including
providing development support, and
monitoring performance and
outcomes
 Direct commissioning, covering
offender health; military health,
specialised commissioning; and
primary care, including management
of family health service functions
 Professional and clinical leadership
 Partner and stakeholder
engagement, including
representation on Health and
Wellbeing Boards
 Co-ordination and oversight of local
offices
 Management of delivery of
specialised commissioning
 Support and co-ordination of clinical
senates and networks
 Performance oversight, including
intervention and failure regime
 Involvement in large scale
reconfigurations
 Co-ordination and oversight of
emergency preparedness
 Stakeholder engagement,
particularly with sub national
presence of bodies such as CQC
and Monitor
 Information functions on behalf of
PEII
8
Now London has 32 ‘emerging CCGs
Enfield
Barnet
Harrow
Waltham
Forest
Haringey
Hillingdon
Brent
Camden Islington
City &
Hackney
emerging CCG
Ealing
Redbridge
Havering
Barking &
Dagenham
Tower Newham
Westminster
Hammersmi
Hamlets
City of London
th & Fulham
Local Authority
West London
Great West Commissioning
Commissioning
Consortium
Southwark
Greenwich
Lambeth
Richmond
All are coterminous with their
local authority except for:
City & Hackney CCG
covers the boroughs of
Hackney and the City of
London
Lewisham
Wandsworth
Bexley
Merton
Kingston
Bromley
Sutton
Croydon
West London
Commissioning covers the
whole of K&C and 12
practices in Westminster
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Three CSSs are taking shape in London, developing cost effective
services that meet the needs of their CCG customers
North West
London: The
emerging CSS
covers a
population of 1.9
million. Their
prospectus
submission was
accompanied by a
signed letter from
all 8 CCG leads,
expressing their
support for the
proposed
commissioning
support service.
Work is underway
to refine the view
of CCGs
intentions, in
particular what
they are planning
to provide inhouse.
South London: The emerging CSS covers a population of
just over 3 million. It has been working with CCGs to
understand more fully their intentions around commissioning
support, where a wide range of plans are developing. Whilst
some CCGs are supportive of a one stop service offering,
others are considering hosting some services in-house or
purchase them from other providers.
North & East
London: The
emerging CSS
covers a population
of just over 3 million.
This organisation
builds on the
commissioning
support
arrangements
already in place in
East London and
the City PCT cluster.
The CSS has had
discussions with all
CCGs to understand
their priorities and
commissioning
support needs.
There is broad
support and as a
result the CSS is
planning on offering
a ‘one stop’
commissioning
support service.
Further work and
engagement will
take place to
validate the
intentions of CCGs.
10
A word on Public Health
The Architecture
• NHS CB - screening, immunisation vaccination
• Public Health England - Health protection scientific advice, information
and intelligence regional leadership
• DPHs in LAs
– health improvement and protection, population health advice to CCGs
and CSSs
– Commissioning of HIV Prevention work most contraceptive services
and all STI/HIV testing services (GUM)
• Health & Wellbeing Boards
– local direction and priorities and Joint Strategic Needs Assessments
• London Health Improvement Board
Any Qualified Provider:
A Changing Provider Landscape
Acute Sector
• Mandatory move to FT status
• Financial viability challenge and the PFI legacy
• Mergers, Acquisitions & Disposals – a role for the
Independent Sector?
• Further specialist designation?
Mental Health, Community & Primary Care
• Transforming Community Services (TCS) agenda
• Opportunities for Independent Providers
• Duty to secure continuous improvement in primary care
Assurance, Governance & Regulation
• The NHS Commissioning Board
– Sub-National committees of the Board
– Specialist committees of the Board
• Provider Development (FT Pipeline) – NHS Trust
Development Authority
• Fitness to Trade – Monitor
• Fitness of Purpose (Clinical Quality) – CQC
• Workforce Development – Health Education England
• Public Health England
Beyond Lansley
Trends & Predictions
• Francis Inquiry
• Continued pressure to invest in community based services and disinvest
in hospitals (but will need to be led by clinicians)
• A greater role for Academic Health Science Centres/Networks
• Continued drive towards AQP – with more divrse range of NHS providers
(including private sector, social enterprises and third sector)
• More specialisation by hospitals and larger multi-purpose trusts
• Unpredictable expressions of localism and expanding role for local
authorities (including further integration of health & social care)
• Increased emphasis on self management and early intervention
… and the Labour Party’s commitments to date:
• An end to AQP (as presently constituted…)
• Consolidation of CCGs
• “No Top Down Reorganization of the NHS”
Opportunities for older deaf and
disabled Londoners
• NHS Constitution
• Local Authorities:
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Public Health
Healthwatch and “Nothing about me without me”
“Integrated Care Pathways”
Health & Wellbeing Boards
Joint Strategic Needs Assessments
• Relationships with CCGs
• Outcomes from Francis Inquiry
• Any Qualified Provider – How can new providers
“add value”
Questions?
www.mbarc.co.uk