Patient and Public Voice in the NHS Commissioning Board

1. Patient and Public Voice in the NHS Commissioning Board September 2011 1

2. Purpose of this document These slides are presented as the basis for discussion and debate. They do not represent fixed policy and may change as a result of the passage of the Health and Social Care Bill through Parliament and wider decisions around the establishment of the NHS Commissioning Board We recognise that further development and testing will enable us to continue to refine and improve current thinking. Whilst this is clearly not a formal consultation we are seeking the widest range of views and are comfortable that you share this widely throughout your networks. 2

3. The NHS reforms will provide a new system landscape • Different architecture for health, social care and public health • Less control and direction from DH • Clear separation of commissioner and provider • Commissioning driven by expert insight from clinicians • Greater partnership working at local level • Clear expectations on choice • Patients and the public involved in commissioning decisions • Commissioners need to be more aware of, and responsive to needs of patients and communities or the new architecture will not be as effective as it could be • This is an important opportunity to bring patient and public voice/power to the fore 3

4. Our intent is to strengthen patient and public voice throughout this new landscape Future: Now : Providers Providers Professionals Professionals Patients and public Patients and public 4

5. We want a new way of working which “brings the outside in” Bringing together: Bringing together: For Governance and accountability In leadership Into Policy Into Design Active secondments Public Community Eg HealthWatch Patient Groups Insight

6. “We also want to ensure that patients and the public influence the Board’s work at every stage of developing policy, strategy and operations. To this end we would expect: To establish a culture and leadership approach which puts engagement and involvement at its heart That the model of engagement adopted by the Board sets the tone for the commissioning system That all staff employed by the Board have core skills in engagement and involvement That our decisions show that the Board knows and understands patient insight and intelligence David Nicholson, Developing the NHS Commissioning Board The commitment to patient and public voice

7. Questions • How do we build a relationship between the Board and voluntary sector that achieves greater patient and public involvement, and supports co-production? • What principles should underpin that relationship? • What needs to be put in place to assure the sector that those principles are being upheld? What signals would you look for from the Board? • What would this mean for the Board’s establishment, and development in the longer-term?

8. Patient and public voice in governance • What should be the main the purpose of patient and public voice within the NHS Commissioning Board? Representation, advice, accountability, something else? • How do we achieve not only breadth but depth? • What the practical considerations that the NHS CB needs to take into account? • Remit? • Election/selection? • Remuneration? • Length of term? • Training and support?

9. What might the “patient voice in governance” model look like? • This is one conceptual “membership” model. Are there other models that the Board should consider adopting? Management Board Shareholder Voice eg. Executive Directors HWBs HealthWatch/FT Govs/PPGs Chair Act as a challenge function Public Non-Executive Directors College Patient Groups Patient Groups/ Communities of interest Act as a challenge function 9

10. Patient and public voice in the work of the Board • The NHSCB will need to draw in high quality, detailed advice and expertise from a wider range of sources, including patient representative bodies, royal colleges and other stakeholder groups. • How do we balance public/patient and professional influence at every table/level? • What arrangements need to be put in place to enable the Board to draw on expertise from the voluntary and community sector in a flexible way? • How do we achieve not only breadth but depth? • What the practical considerations that the NHS CB needs to take into account to do this?

11. Chief Executive Management Board Board Directors Lay Advisory Structure Management Committee Clinical Committee Clinical Committee Management Committee Divisional Committee Management Committee Divisional Committee Divisional Committee Management Committee Co-production Task & Finish Groups What could the “lay” advisory system look like? This is one option, but are there other advisory models we should consider? 11