Transcript Presentation Heading

Equity and Excellence: Liberating the
NHS
Briefing for Children’s Trust Board
21 September 2010
Marion Dinwoodie
Chief Executive
NHS Medway
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White paper headlines
• Putting patients and the public first
“No decision about me, without me”
• Focus on improvement in quality and healthcare outcomes
• Autonomy, accountability and democratic legitimacy
• Cutting bureaucracy and improving efficiency
• £20bn by 2014 reinvested to support quality and outcomes
• Reduction of 45% in NHS management costs over four
years
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White paper headlines 2
• Independent and accountable NHS Commissioning Board
• Power and responsibility for commissioning devolved to GP
consortia, accountable to the NHS Commissioning Board
• Local Authorities to promote joining up of local NHS
services, social care and health improvement
• Ring-fenced Public Health Budget
• HealthWatch funded by and accountable to local authorities
• Monitor will be economic regulator
• Strengthened role of CQC in health and social care
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Timetable
• Shadow NHS Commissioning Board established as a
special health authority from April 2011
• Commissioner/provider split completed by April 2011
• Independent NHS Commissioning Board fully
established by April 2012
• GP consortia established in shadow form from 2011/12
• Autumn 2012 NHS Commissioning Board makes
allocations for 2013/14 direct to GP consortia
• April 2013 GP consortia hold contracts with providers
• SHAs will no longer exist from 2012/13, PCTs from April 2013
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Consultation process
• Consultation process ends 11 October
• Consultation will:
 Involve public, patients, GPs, health and social care
professionals, local gov, voluntary and independent sector
 Be carried out in partnership with external organisations
 Look to models of good practice
 Inform the development of Impact Assessments to be
published later in 2010
• Examples of existing practice and evidence that supports
respondents’ views are encouraged
• The government will publish a response prior to the
introduction of a Health Bill later this year
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Consultation documents
• Consultation documents published to date
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Commissioning for patients
Local democratic legitimacy in health
Freeing providers and economic regulation
The NHS Outcomes Framework
• Documents to come
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HR framework
Information strategy
Workforce Planning
Education and training
Accessing cancer drugs
Extending and expanding choice
• Public Health White Paper published later in 2010
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The role of PCTs during transition
• Support and enable the new GP consortia
• Deliver the QIPP agenda
• Build relationships with the new patient and public
arrangements (local HealthWatch)
• Engage with clinical leaders and partners to build support
and understanding for the changes
• Work with Local Authorities and other social care partners
to manage financial and service pressures
• Work to ensure the sustainability of key systems and
processes through the transition period
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GP consortia
• Authorised and held to account by the NHS Commissioning
Board
• Consortia will work closely with secondary care, health and
care professionals and community partners to design joinedup services
• Not all GPs will need to be actively involved, a small group
could lead the consortium and clinical design of services
• Consortia can employ staff or buy in external support, e.g. to
analyse health needs, manage contracts and monitor spend
and outcomes
• NHS Commissioning Board will develop commissioning
guidelines, model contracts and tariffs
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GP consortia responsibilities
• Responsible for commissioning the great majority of
services including:
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Elective hospital care
Rehabilitative care
Urgent and emergency care
Out of hours services
Most community health services
Mental Health
Learning Disability services
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GP consortia responsibilities
• Consortia won’t commission primary medical services but
will be influential in driving up quality and can commission
enhanced services
• NHS Commissioning Board will commission primary
medical care, dentistry, pharmacy, ophthalmic, maternity,
prison and specialist national and regional services
• Consortia have a duty to promote equalities, work with
Local Authorities and engage and involve public and
patients
• Consortia will develop their own arrangements to hold
constituent practices to account
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GP consortia funding
• Local Authorities may, where agreed, support joint
commissioning and pooled budget arrangements
• NHS Commissioning Board will calculate practice-level
budgets and allocate to consortia
• Budgets will be separate from GP practice income but
some could be linked to outcomes and management of
resources
• Consortia must ensure spend does not exceed allocated
resources
• Consortia will hold contracts with providers and hold
them to account for quality standards and outcomes
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Accountabilities
• NHS Commissioning Board will develop a commissioning
outcomes framework to make information available to the
public on:
 Quality of healthcare services
 PROM measures (Patient Recorded Outcome Measures)
 Management of resources
 Progress in reducing health inequalities
• NHS Commissioning Board will have powers to intervene if
consortia are ineffective or there is significant risk of failure
• Criteria/triggers for intervention will be developed
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Local democratic accountability in
health: The role of Local Authorities
• Take the lead in joint strategic needs assessments across
health and local government services
• Promote joint commissioning between GP consortia and
Local Authorities
• Take the NHS constitution into account when influencing
commissioning decisions about NHS service
• Support local voice and the exercise of patient choice
• Further integrate health with adult social care, children’s
services (including education) and wider services including
disability services, housing, tackling crime and disorder
• Lead on local health improvement and prevention activity
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Changes to Public Health
• Public Health White Paper to be published late 2010
• By April 2012 national Public Health Service in place with a lead
role on public health evidence and analysis
• Ring-fenced budget and local health improvement led by
Directors of Public Health jointly employed by local authorities
and the Public Health Service
• Arrangements to support shadow health and wellbeing
partnerships begin April 2011
• Local authority health and wellbeing boards in place by April 2012
• Ring-fenced budget reflecting local health outcomes and health
inequalities
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Strengthened integration
• Government to explore benefits of place-based budgets for areas,
e.g. older people’s services and substance misuse
• Extended availability of personal budgets in the NHS and social
care, with joint assessment and care planning
• Quality standards across patient pathways, e.g recently published
NICE dementia standard
• CQC as effective inspector of quality standards spanning health
and social care
• Payment systems to support joint working, e.g. payment by
results and hospital readmissions
• Providers freed up to innovate, e.g. foundation trusts could
expand into social care
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Health and wellbeing boards
• Statutory board is government’s preferred option, subject to
consultation
• “Minimal requirements, maximum freedom and flexibility”
• Replaces current Health Partnership Boards and OSCs
• Would bring together mix of elected members and officials
including Council Leader, Social Care, Public Health, NHS
Commissioners, GP consortia, local government and patient
champions
• Voluntary sector, other public services and providers can be
invited to participate
• Chair to be decided by elected members
• NHS Commissioning Board will attend when relevant
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Health and wellbeing boards 2
• Promotes integration and partnership working between
the NHS, social care, public health and other local
services
• Assesses local need, leads joint strategic needs
assessment for coherent and co-ordinated
commissioning strategies
• Determines strategy and allocation of place-based
budgets
• Supports joint commissioning and pooled budget
arrangements where all parties agree this makes sense
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Health and wellbeing boards 3
• Resolves or escalates to national NHS Commissioning
Board concerns about local partnerships, e.g. children’s
safeguarding
• Has strategic oversight of health and social care
services
• Resolves concerns about service changes and
scrutinises major service redesign
• Has a role in enabling NHS Commissioning Board to
assure itself that GP consortia are responsive to
patients and public
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Role of HealthWatch
• A more powerful and stable “local consumer champion”
for health and social care
• Will sit on Health and Wellbeing Boards
• Continues to promote patient and public involvement
and seek views on local health and social care services
• Becomes a “citizen’s advice bureau” for health and
social care, providing a signposting function
• Supports individuals to exercise choice, e.g. choice of
GPs
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Role of HealthWatch 2
• Commissioned by Local Authorities to provide an NHS
complaints advocacy service (currently provided by the
Independent Complaints Advocacy Service)
• Can be replaced by Local Authorities in the event of
under performance
• Can report concerns about provision of local NHS or
social care services to HealthWatch England,
independently of host Local Authority
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The NHS Outcomes Framework
• Sets out how the Secretary of State will hold the NHS to account
• Focus at a national level is on outcomes of care… locally structures
and processes of care will also need to be monitored
• Will act as a catalyst for driving up quality …not as a tool to
performance manage providers
• NHS Commissioning Board will determine how best to deliver
improvements using:
 Quality Standards from NICE
 Payment mechanisms and incentive schemes such as CQUINs
 Set of indicators to “operationalise” the national outcome goals
 Commissioning framework for GPs
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Accountability and transparency
• NHS Outcomes Framework data will be publicly
available
• Balanced set of outcomes will be chosen to hold NHS
Commissioning Board to account, spanning
Effectiveness, Patient Experience, Safety
• The outcome measures will cover clinical outcome
measures as well as PROMS
• Will recognise importance of reducing inequalities and
promoting equality
• Outcomes will be measured by different equalities
characteristics and by local area
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Structure of the Framework
• NHS Outcomes Framework to be developed around five
outcome domains:
 Preventing people from dying prematurely
 Enhancing quality of life for people with long-term conditions
 Helping people to recover from episodes of ill health or
following injury
 Ensuring people have a positive experience of care
 Treating and caring for people in a safe environment and
protecting them from avoidable harm
• Each domain will have an overarching set of indicators
• Over 5 years NICE will develop 150 quality standards
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DRAFT 10/8/10
What
happens
next?
NHS Medway
Board
Transition Board
(MD - Chair, S.Gee, WH, AB,
PG, HB, Neil Davies, LINk, PB, JB, LK, ND,
other GPs)
LA Transition
(AB-Chair,
HB, LA Rep)
GP Consortia
(PG)
Organisation
Form
(ND)
OD Clinician
GPs, WH
Finance
(JB)
Public
Health
(AB)
LA Relationship
(HB, LA
Representative)
Next Steps
Plans / timescales
Health
Improvement
(SAI)
TCS
(MD-Chair, WH)
Scrutiny of
Service
Reconfiguration
(ND)
Integrated
commissioning
(LK, HB, LA rep)
New role of
LINk, PALS,
Complaints
(ND)
General
(WH)
Safeguarding/
Quality
(PB)
Early Years
(SM)
Dispute
Resolution
(HB, LA rep)
Inventory of
current functions
(WH)
Estates, IT,
Infrastructure
(JB)
People /
Workforce
(WH)
EP
(ND,AB)
Communications
(NY)
Handover to
successor
organisations
(ND)
Work Group members; Staff, GPs
Work assumptions – look to future
Communications to organisation
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Thank you
Any Questions?
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