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This is a very brief overview of the Health and Social Care Act 2012 and related organisational changes:

North of England Mental Health Development Unit. Health and Social Care Act 2012. Local Democratic Legitimacy in health. Regulating Healthcare providers. The review of arms length bodies. Transparency in outcomes: a framework for the NHS. Commissioning for Patients.

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This is a very brief overview of the Health and Social Care Act 2012 and related organisational changes:

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  1. North of England Mental Health Development Unit Health and Social Care Act 2012 Local Democratic Legitimacy in health Regulating Healthcare providers The review of arms length bodies Transparency in outcomes: a framework for the NHS Commissioning for Patients The Health and Social Care Bill received Royal Assent on 27 March 2012, to become the Health and Social Care Act 2012. Please note: rather than a traditional power point presentation this document is a visual adaptation of the Act and its supporting documents and how they are linked together. To use the document simply use slide two as your home page throughout, using your mouse to click on each of the light blue highlighted words to take you to a page with a little more information on that topic or organisation. From each information page, simply click your mouse on the box to return to the diagram on slide two. If you are just using a print out each box in the diagram on page two has a number in it referring the page where you can find a little more information on that topic. N.B. This is an interpretation by NEMHDU of the Act and is not a substitute for reading the Act and supporting documents in full – active web links to documents can be found at the end of each topic. PJ-MJ/March 2013/Version 6 This is a very brief overview of the Health and Social Care Act 2012 and related organisational changes: Back to home 1

  2. Secretary of state NHS Outcomes Framework 3 Public Health Outcomes framework 5 Adult Social Care Outcomes Framework 7 Overlapping frameworks diagram can be found on page 8 NHS Commissioning board 9 NICE 11 Public Health England 12 CQC 13 Health Watch England 14 Monitor 15 Office of Fair Trading16 CCG Outcomes Indicator Set 17 Local Health Watch 25 Local Area Teams 18 Public Health 24 Clinical Commissioning groups 21 Health & Wellbeing Boards 28 Local Authority 23 Foundation Trusts 32 Clinical Senates & SCNs 19 JSNA + Joint Health and Wellbeing Strategy 31 Commissioning Support Units 22 Independent sector Patients carers and the public 2

  3. The NHS Outcomes Framework 2013/14 The purpose of the NHS Outcomes Framework is threefold: • to provide a national level overview of how well the NHS is performing; • to provide an accountability mechanism between the Secretary of State for Health and the NHS Commissioning Board for the effective spend of some £95bn of public money; • to act as a catalyst for driving up quality throughout the NHS by encouraging a change in culture and behaviour. Indicators in the NHS Outcomes Framework are grouped around five domains, which set out the high-level national outcomes that the NHS should be aiming to improve. For each domain, there are a small number of overarching indicators followed by a number of improvement areas. They focus on improving health and reducing health inequalities: Domain 1: Preventing people from dying prematurely Domain 2: Enhancing quality of life for people with long-term conditions Domain 3: Helping people to recover from episodes of ill health or following injury Domain 4: Ensuring that people have a positive experience of care Domain 5: Treating and caring for people in a safe environment, and protecting them from avoidable harm. Continued on next page

  4. The NHS Outcomes Framework – continued... The NHS Outcomes Framework sits alongside similar frameworks for public health and adult social care. The distinct frameworks reflect the different delivery systems and accountability models for the NHS, public health and adult social care. The three frameworks have been further aligned to encourage collaboration and integration, both in terms of how shared and complementary indicators are presented across all three frameworks, and through an increased and more systematic use of shared and complementary indicators in the revised Public Health and Adult Social Care Outcomes Frameworks for 2013/14. From April 2013, the NHS Outcomes Framework will form part of the way in which the Secretary of State will hold the new NHS Commissioning Board to account for the commissioning system in the English NHS. The mandate to the NHS Commissioning Board represents the first time that the Government has been legally required to set out the objectives for the NHS, and provides an important degree of transparency. Back to home NHS Outcomes Framework information taken from: The NHS Outcomes Framework 2013/14 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/127106/121109-NHS-Outcomes-Framework-2013-14.pdf.pdf 4

  5. Public Health Outcomes Framework for England, 2013-2016 The new public health outcomes framework “Health Lives, Healthy People: improving outcomes and supporting transparency” is in three parts: • Part 1 introduces the overarching vision for public health, the outcomes, and the indicators that will help us understand how well we are improving and protecting health. • Part 2 specifies all the technical details the DH can currently supply for each public health indicator and indicates where they will conduct further work to fully specify all indicators. • Part 3 consists of the impact assessment and equalities impact assessment. The Outcomes Framework details two high level outcomes and four domains, which are shown on the following page. Continued on next page Information taken from: Healthy Lives, Healthy People: Improving outcomes and supporting transparency http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_132358

  6. Back to home Public Health Outcomes Framework continued…

  7. Back to home The Adult Social Care Outcomes Framework 2013/14 The adult social care outcomes framework sets out agreed outcome measures in four domains: • Enhancing quality of life for people with care and support needs • Delaying and reducing the need for care and support • Ensuring that people have a positive experience of care • Safeguarding adults whose circumstances make them vulnerable and protecting from avoidable harm The Adult Social Care Outcomes Framework (ASCOF) fosters greater transparency in the delivery of adult social care, supporting local people to hold their council to account for the quality of the services they provide. A key mechanism for this is through councils’ local accounts, where the ASCOF is already being used as a robust evidence base to support councils’ reporting of their progress and priorities to local people; View overlapping outcome frameworks diagram Information taken from: The adult social care outcomes framework 2013/14: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/141627/The-Adult-Social-Care-Outcomes-Framework-2013-14.pdf

  8. Back to home The three overlapping frameworks for the NHS, public health and adult social care services Public Health Adult Social Care and Public Health Maintaining good health and wellbeing. Preventing avoidable ill health or injury, including through reablement or intermediate care services and early intervention. NHS and Public Health Preventing ill health and lifestyle diseases and tackling their determinants. Adult Social Care and NHS Supported discharge from NHS to social care. Impact of reablement or intermediate care services on reducing repeat emergency admissions. Supporting carers and involving in care planning. Adult Social Care NHS Adult Social Care, NHS and Public Health The focus of Joint Strategic Needs Assessment: shared local health and wellbeing issues for joint approaches. Information taken from: Healthy Lives, Healthy People: Transparency in outcomes; proposals for a public health outcomes framework – a consultation document https://shareweb.kent.gov.uk/Documents/health-and-wellbeing/Transparency%20in%20outcomes.pdf

  9. Role of the NHS Commissioning Board • The NHS Commissioning Board take on its full range of responsibilities as from April 2013, and the new commissioning system will begin to operate, the Board will develop: • A framework that provides clarity about the outcomes for which clinical commissioning groups (CCGs) are accountable and the resources available to them; (CCG Outcomes Indicator Set) • A range of tools to support effective commissioning, but which CCGs can adapt to reflect local needs – including commissioning guidance, model pathways, and standard contracts – supported by the best available evidence on how to secure improvements in quality, productivity and health outcomes; • A continuing programme to help CCGs understand their strengths and be aware of areas that need improvement, along with appropriate development opportunities to address their needs; • A robust system of authorisation to ensure that CCGs take on commissioning and budgetary responsibilities at the right pace, together with ongoing assurance based on the outcomes that they are achieving for patients; and • A transparent and rules-based approach that enables the Board to intervene to support CCGs that are in difficulty, whilst promoting autonomy and allowing successful commissioners freedom to innovate. Continued on next page NHS Commissioning Board information taken from: Developing the NHS Commissioning Board http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_128196.pdf 9

  10. NHS Commissioning Board – continued... Key frameworks to deliver the work of the NHS Commissioning Board Back to home Secretary of State for Health National mandate NHS Commissioning Board • NHS Outcomes Framework • Leadership for clinical improvement • Improvement for strategies and model • Quality Standards/NICE • Accountability framework • Finance and allocations • Planning and oversight • Authorisation & assurance • Choice framework • Choice offer • Contract design/development • Tariff design/pricing (with Monitor) Emergency planning framework Clinical commissioning groups and national and local strategic partners

  11. Back to home • National Institute for Health and Clinical Excellence (NICE) • NICE is to be given greater autonomy to serve patients and professionals through the provision of clinical advice and information. • Commissioners will draw from the NICE library of standards as they commission care. Clinical commissioning groups and providers will agree local priorities for implementation each year, taking account of the NHS Outcomes Framework. NICE quality standards will be reflected in commissioning contracts and financial incentives. Together with essential regulatory standards, these will provide the national consistency that patients expect from their National Health Service. • Progress on outcomes will be supported by quality standards. These will be developed for the NHS Commissioning Board by NICE, who will develop authoritative standards setting out each part of the patient pathway, and indicators for each step. In March 2012, the Department of Health referred a library of quality standard topics to NICE for development. • Recent health reforms have outlined a role for NICE to work alongside the NHS Commissioning Board, and professional and patient groups, to develop a commissioning outcomes framework (COF). This will measure the health outcomes and quality of care achieved by clinical commissioning groups. Information on NICE quality standards can be found at: http://www.nice.org.uk/aboutnice/qualitystandards/qualitystandards.jsp 11

  12. Back to home Public Health England Public Health England was created in 2012, taking on full responsibilities from 2013. Public Health England is an Executive Agency, within a structure accountable to the Secretary of State for Health, and brings together the functions of the former: • Health Protection Agency • National Treatment Agency for Substance Misuse • Regional Directors of Public Health and their teams in DH and SHAs • Regional and specialist Public Health Observatories • Cancer Registries and the National Cancer Intelligence Network • National Screening Committee and Cancer Screening Programmes. Public Health England is part of the Government’s proposals to develop a radical new approach that will empower local communities, enable professional freedoms and unleash new ideas based on the evidence of what works, while ensuring that the country remains resilient to and mitigates against current and future health threats. Public Health England will: • bring together a fragmented system • do nationally what needs to be done • have a new protected public health budget • support local action through funding and the provision of evidence, data and professional leadership. Information taken from: Healthy Lives, Healthy People: Our strategy for public health in England https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/151764/dh_127424.pdf.pdf And Healthy Lives, Healthy People: Update and Way Forward (July 2011) http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_128120

  13. Back to home • Care Quality Commission • The Care Quality Commission inspects providers against essential levels of safety and quality in a targeted and risk-based way, taking into account information it receives about a provider. This information will come through a range of sources including patient feedback and complaints, HealthWatch England, Clinical Commissioning Groups and the NHS Commissioning Board. Where inspection reveals that a provider is not meeting essential levels of safety and quality, the Care Quality Commission will take enforcement action to bring about improvement. • In relation to the, NHS the Care Quality Commission (CQC) will, together with Monitor, operate a joint licensing regime. The Care Quality Commission and Monitor already have a duty of co-operation in primary legislation to work closely together to ensure that the regulatory burden of multiple licences is reduced, whilst ensuring robust and proportionate regulation. Under the Health and Social Care Act 2012, the CQC also has a duty to co-operate with the NHS Commissioning Board, NICE, the Health and Social Care Information Centre and Special Health Authorities. • HealthWatch England, a new independent consumer champion from October 2012, which will be an advocate for patients’ rights and concerns, will be constituted as a statutory committee of the Care Quality Commission and will enjoy the benefits of the Care Quality Commission’s independence and scale of operations, including avoiding duplicating work on the assessment of public opinions on health and care issues. CQC information taken from: Liberating the NHS: Legislative Framework & Next Steps + Health & Social Care Act 2012 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_122707.pdf http://www.legislation.gov.uk/ukpga/2012/7/pdfs/ukpga_20120007_en.pdf 13

  14. HealthWatch England HealthWatch England was established in Oct 2012 as the new consumer champion for health and adult social care in England. From April 2013 Healthwatch England will be part of a new Healthwatch network giving people who use health and social care services a powerful voice locally and nationally. For the first time this will clearly provide a platform for making the NHS and local government accountable to their local communities. HealthWatch England will have three main functions: It will provide leadership, guidance and support to local HealthWatch organisations. It will be able to escalate concerns about health and social care services raised by local HealthWatch to CQC. CQC will be required to respond to advice from its HealthWatch England subcommittee. 3. It will provide advice to the Secretary of State, NHS Commissioning Board, Monitor and the English local authorities, and they are required to respond to that advice. The Secretary of State for Health will be required to consult HealthWatch England on the mandate for the NHS Commissioning Board. Back to home HealthWatch information taken from: Preparing for Healthwatch – CQCs plan to set up Healthwatch England http://www.cqc.org.uk/sites/default/files/media/documents/preparing_for_healthwatch.pdf http://www.healthwatch.co.uk/about-us 14

  15. Back to home Monitor Under the Health and Social Care Act 2012 Monitor will become the sector regulator for health. Monitor’s core duty will be to protect and promote patients' interests. Monitor’s main functions, as described in the Health and Social Care Act (2012), are: Regulating Prices The Government has announced that Monitor will take on responsibility for pricing, working together with the NHS Commissioning Board. Enabling integrated care and preventing anti-competitive behaviour Monitor will have a duty to consider how it can enable or facilitate integrated care, alongside ensuring that competition is fair and that it operates in the interests of patients. Supporting service continuity Monitor would support commissioners to ensure that patients could continue to access the care that they need if a healthcare provider fails. Licensing Providers In carrying out its sector regulator role, Monitor will license providers of NHS services in England. Assessing and regulating NHS Foundation Trusts Under the Health and Social Care Act (2012) Monitor will have a continuing role in assessing NHS trusts for foundation trust status, and for ensuring that foundation trusts are financially viable and well-led, in terms of both quality and finances. Monitor information taken from: Monitor website:http://www.monitor-nhsft.gov.uk/monitors-new-role

  16. Back to home Office of Fair Trading The Office of Fair Trading (OFT) and Monitor must co-operate with each other in the exercise of their respective functions under the Competition Act 1998 and the Enterprise Act 2002. The OFT plans to work constructively with other government departments and public bodies, to help them frame and deliver services that work well for citizens and taxpayers. In particular: • continuing to work with DH in relation to the Health and Social Care Bill, identifying and addressing competition and consumer issues across the healthcare sector • where regulators have been given greater responsibilities for overseeing competition in their sector, for example, Monitor in relation to healthcare • continuing to work with public sector bodies to raise awareness of how competition law applies to them, building on the OFTs recent guidance Office of Fair Trading information taken from: Office of Fair Trading Annual Plan 2012-13: http://www.oft.gov.uk/shared_oft/about_oft/ap12/OFT1382.pdf

  17. CCG Outcomes Indicator Set The Clinical Commissioning Group Outcomes Indicator Set (CCG OIS) (formerly known as the Commissioning Outcomes Framework) is an integral part of the NHS Commissioning Board's systematic approach to quality improvement. Its primary aim is to support and enable clinical commissioning groups (CCGs) and health and wellbeing partners to plan for health improvement by providing information for measuring and benchmarking outcomes of services commissioned by CCGs. It is also intended to provide clear, comparative information for patients and the public about the quality of health services commissioned by CCGs and the associated health outcomes. The consultation document ‘Liberating the NHS: Commissioning for Patients' proposed that the NHS Commissioning Board, supported by NICE, would develop a ‘Commissioning Outcomes Framework' to hold CCGs to account for, and provide information for the public on the quality of services they commission and the health outcomes achieved through commissioning. Following engagement with stakeholders, the NHS Commissioning Board has changed the title to avoid confusion with the NHS Outcomes Framework and make it clear that the indicators relate to outcomes of commissioned services, not commissioning itself. Back to home Clinical Commissioning Group Outcomes Indicator Set information taken from the NICE website: http://www.nice.org.uk/aboutnice/cof/cof.jsp 17

  18. Back to home NHS Commissioning Board Local Area Teams There are 27 Local Area Teams, with 9 in the North of England: Cheshire, Warrington & Wirral Durham, Darlington & Tees Greater Manchester Lancashire Merseyside Cumbria, Northumberland, Tyne & Wear North Yorkshire & Humber South Yorkshire & Bassetlaw West Yorkshire All LATs will have the same core functions around: • CCG development and assurance • emergency planning, resilience and response • quality and safety • partnerships • configuration • system oversight There will be variations around the scope of direct commissioning responsibilities, however all local area teams will take on direct commissioning responsibilities for GP services, dental services, pharmacy and certain aspects of optical services. Information from: NHS Commissioning Board Local Area Teams Staff Briefing Pack; June 2012 http://www.commissioningboard.nhs.uk/wp-content/uploads/2012/06/lat-senates-pack.pdf 18

  19. Clinical Senates Clinical Senates will bring together a range of professionals to take an overview of health and healthcare for local populations and provide a source of strategic, independent advice and leadership on how services should be designed to provide the best overall care and outcomes for patients. Clinical Senates will draw on a variety of health and wider care perspectives, including those of professionals who sometimes go unheard. To support the better integration of services, they will include public health specialists and adult and children’s social care experts. They will provide a clinically led and strategically focussed space for commissioners and providers to come together and determine the most clinically appropriate way to configure services for the future. Reinforcing the critical importance of clinical leadership in the health service, Clinical Senates will help Clinical Commissioning Groups, Health and Wellbeing Boards and the NHS Commissioning Board to make the best decisions about healthcare for the populations they represent by providing clinical advice and leadership at a strategic level. Each Clinical Senate area will have a senate and network support team, supporting four nationally agreed strategic clinical networks. Continued on next page Information from: NHS Commissioning Board Clinical Senates Update; January 2013 http://www.commissioningboard.nhs.uk/wp-content/uploads/2013/01/cs-update.pdf 19

  20. Back to home Strategic Clinical Networks SCNs operate as engines for change across complex systems of care, maintaining and or improving quality and outcomes. They bring primary, secondary and tertiary care clinicians together with partners from social care, the third sector and patients. • NHS Commissioning Board will host Strategic Clinical Networks (SCNs) from 2013, via Local Area Teams • Four initial network areas operating throughout the country: • cancer • cardiovascular • maternity and children • mental health, dementia and neurological conditions • SCNs will be non-statutory organisations • SCNs will have an annual accountability agreement with the NHS Commissioning Board for delivering a programme of quality improvement, as defined by Domain Leads and local partners Information from: NHS Commissioning Board Strategic Clinical Networks Update; November 2012 http://www.commissioningboard.nhs.uk/wp-content/uploads/2012/11/scn-update.pdf and NHS Commissioning Board Strategic Clinical Networks Single Operating Framework: http://www.commissioningboard.nhs.uk/wp-content/uploads/2012/11/scn-sof.pdf 20

  21. Back to home Clinical Commissioning Groups From April 2013 the whole of England will be covered by Clinical Commissioning Groups (CCGs). CCGs will be responsible for commissioning a range of services, previously commissioned by Primary Care Trusts. Commissioning Support Services – to support CCGs and the NHS Commissioning Board – are being developed. Qualities required of a successful Clinical Commissioning Group, broadly grouped into six domains, are: • A strong clinical and multi-professional focus which brings real added value • Meaningful engagement with patients, carers and their communities • Clear and credible plans which continue to deliver the QIPP (Quality, Innovation, Productivity and Prevention) challenge within financial resources, in line with national requirements (including excellent outcomes), and local joint health and wellbeing strategies • Proper constitutional and governance arrangements, with the capacity and capability to deliver all their duties and responsibilities including financial control, as well as effectively commission all the services for which they are responsible • Collaborative arrangements for commissioning with other CCGs, local authorities and the NHS Commissioning Board as well as the appropriate external commissioning support • Great leaders who individually and collectively can make a real difference. All GPs are required to be members of a Clinical Commissioning Group. CCG information taken from: Developing Clinical Commissioning Groups: Towards Authorisation http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_130293 21

  22. Back to home Commissioning Support Units For some support activities, CCGs may choose to appoint their own internal staff while for others they will have a choice of using new CSUs or other sources of commissioning support, eg. from the independent or voluntary sectors. CCGs will always retain legal accountability and responsibility for meeting their statutory functions and their commissioning decisions cannot be delegated to others. The NHS CB will host all CSUs from April 2013 through to the point at which CCGs procure their choice of future commissioning support. Initially, the intention is that CCGs will identify a hosted CSU and this arrangement will operate under a standard contract. This will ensure: • Stability in the system while CCGs secure ongoing commissioning support • The experience and expertise of staff in commissioning support roles in PCTs is retained for the benefit of the NHS • CSUs, as new organisations, have the time to develop to become customer- driven businesses that are capable of being independently sustainable within a competitive marketplace. The host role is in effect a ‘holding company’ which covers: • Ownership of the NHS CSUs • Accountability and responsibility • A legitimate operating framework for CSUs in terms of statutory cover and a financial operating model • An interim trading environment to support delivering contracted services to CCGs. • NHS CSUs will legally be part of the NHS CB and have no independent legal status until they are externalised (by 2016). Commissioning Support Unit Information from: NHS CB Commissioning Support: Key Facts: http://www.commissioningboard.nhs.uk/wp-content/uploads/2012/11/csu-fact-oct.pdf

  23. Local Authorities Each local authority will take on the function of joining up the commissioning of local NHS services, social care and health improvement. Local authorities will therefore be responsible for: Promoting integration and partnership working between the NHS, social care, public health and other local services and strategies; Producing in partnership with Clinical Commissioning Groups joint strategic needs assessments and joint health and wellbeing strategies that will inform locality commissioning plans which will be done through the health and wellbeing boards Building partnership for service changes and priorities. There will be an escalation process to the NHS Commissioning Board and the Secretary of State, which retain accountability for NHS commissioning decisions. These functions would replace the current statutory functions of Health Overview and Scrutiny Committees. LAs will have an enhanced role in promoting choice and complaints advocacy, through the HealthWatch arrangements they will commission. LAs will have nationally set targets to improve population health outcomes. They will employ Directors of Public Health, who will be jointly appointed with the Public Health Service. Back to home Local Authorities information taken from: Equity and Excellence: Liberating the NHS http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_117794.pdf 23

  24. Back to home Public Health From April 2013, upper-tier and unitary local authorities will have a new duty to take steps to improve the health of their population. While local authorities will be largely free to determine their own priorities and services, they are required to have regard to the Public Health Outcomes Framework. Local authorities will also be required to provide a small number of mandatory services including: • appropriate access to sexual health service; • NHS Health Check assessments • steps to be taken to protect the health of the population, in particular, giving the local authority the responsibility to make plans are in place to protect the health of the population; • weighing and measuring children for the National Child Measurement Programme; • providing public health advice to NHS commissioners. To enable them to deliver these new public health functions, local authorities will, acting jointly with Public Health England, appoint directors of public health who will occupy key leadership positions within the local authority and will be statutory members of the Health and Wellbeing Board. Information taken from: Healthy Lives, Healthy People: Our strategy for public health in England https://www.gov.uk/government/publications/healthy-lives-healthy-people-our-strategy-for-public-health-in-england

  25. Local HealthWatch Local HealthWatch organisations will be funded via local authorities and will be accountable to local authorities for operating effectively and providing value for money. Local authorities will have the responsibility for putting in place different arrangements if a local HealthWatch organisation is not operating effectively. At least one representative of local HealthWatch will sit on the new local authority health and wellbeing boards helping to ensure that the consumer voice is integral to the wider, strategic decision–making across local NHS services, adult social care and health improvement. HealthWatch will give local communities a bigger say in how health and social care services are planned, commissioned, delivered and monitored to meet the health andwellbeing needs of local people and groups, and address health inequalities. It will strengthen the voice of local people and groups, helping them to challenge poor quality services. HealthWatch will have an important role supporting everyone in the community, but particularly those who are vulnerable or often unheard. Local HealthWatch will provide information about health and care services and about the choices people can make. From April 2013 it will provide support for people to complain about the quality of NHS services. Continued on next page

  26. Local HealthWatch continued… It is proposed that local HealthWatch will: • provide information and advice to the public about accessing health and social care services and choice in relation to aspects of those services; • make the views and experiences of people known to Healthwatch England helping it to carry out its role as national champion; • make recommendations to Healthwatch England to advise the Care Quality Commission to carry out special reviews or investigations into areas of concern (or, if the circumstances justify it, go direct to the CQC with their recommendations, for example if urgent action were required by the CQC); • promote and support the involvement of people in the monitoring, commissioning and provision of local care services; • obtain the views of people about their needs for and experience of local care services and make those views known to those involved in the commissioning, provision and scrutiny of care services; and • make reports and make recommendations about how those services could or should be improved. From April 2013, local authorities will commission NHS complaints advocacy from any suitable provider, including local HealthWatch, and the service will be accessed through local HealthWatch. HealthWatch information taken from: Local HealthWatch: A strong voice for people – the policy explained http://healthandcare.dh.gov.uk/healthwatch-policy/ Continued on next page

  27. Back to home Local HealthWatch – continuing LINk functions and acquiring new functions Representing the local voice Strong LOCAL consumer voice on views and experiences to influence better health and social care outcomes Respected, authoritative, influential, credible and very visible within the community Scrutinising quality of service provision Seat on the health and wellbeing board Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy From 2013/14 Empowering people – helping people understand choice Informing the commissioning decision-making process Providing local, evidence based information

  28. Health and wellbeing boards The core purpose of the new health and wellbeing boards is to join up commissioning across the NHS, social care, public health and other services that the board agrees are directly related to health and wellbeing. Health and wellbeing boards will be the engine room to develop joint strategic needs assessments and joint health and wellbeing strategies as the foundation for 2013/14 commissioning plans, but also bring together services through joint commissioning. Underlying principles of boards A number of principles underlie the creation of health and wellbeing boards. These include: shared leadership of a strategic approach to the health and wellbeing of communities that reaches across all relevant organisations a commitment to driving real action and change to improve services and outcomes parity between board members in terms of their opportunity to contribute to the board’s deliberations, strategies and activities Continued on next page Health and Wellbeing Boards information taken from: Liberating the NHS: Legislative Framework and Next Steps http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_122707.pdf 28

  29. Underlying principles of Health and Wellbeing Boards – Continued... • shared ownership of the board by all its members (with commitment from their nominating organisations) and accountability to the communities it serves • openness and transparency in the way that the board carries out its work • inclusiveness in the way it engages with patients, service users and the public. • The legislation was aimed at allowing considerable flexibility to councils and their • partners on health and wellbeing boards to set up and run boards that conform to these principles in a way that suits local circumstances. This means that a range of options will be possible. • Functions of Health and Wellbeing Boards • The Health and Social Care Act 2012 gives health and wellbeing boards specific • functions. These are a statutory minimum and further functions can be given to the boards in line with local circumstances. The statutory functions are: • To prepare Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies (JHWSs), which is a duty of local authorities and clinical commissioning groups (CCGs). Continued on next page

  30. Back to home • Functions of Health and Wellbeing Boards – Continued... • A duty to encourage integrated working between health and social care commissioners, including providing advice, assistance or other support to encourage arrangements under section 75 of the National Health Service Act 2006 (ie. lead commissioning, pooled budgets and/or integrated provision) in connection with the provision of health and social care services. • A power to encourage close working between commissioners of health-related services and the board itself. • A power to encourage close working between commissioners of health-related services (such as housing and many other local government services) and commissioners of health and social care services. Health and Wellbeing Boards information taken from: Health and Wellbeing Boards: A practical guide to governance and constitutional issues; LGA; March 2013 http://www.local.gov.uk/c/document_library/get_file?uuid=ca8437aa-742c-4209-827c-996afa9583ca&groupId=10171

  31. Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategies Joint Strategic Needs Assessments (JSNAs) are assessments of the current and future health and social care needs of the local community – these are needs that could be met by the local authority, CCGs, or the NHS Commissioning Board. JSNAs are produced by health and wellbeing boards, and are unique to each local area. Joint Health and Wellbeing Strategies (JHWSs) are strategies for meeting the needs identified in JSNAs. As with JSNAs, they are produced by health and wellbeing boards and are unique to each local area. In preparing JHWSs, health and wellbeing boards must have regard to the Secretary of State’s mandate to the NHS Commissioning Board which sets out the Government’s priorities for the NHS. They should explain what priorities the health and wellbeing board has set in order to tackle the needs identified in their JSNAs. Back to home Information from: Statutory Guidance on Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies DH; March 2013 https://s3-eu-west-1.amazonaws.com/media.dh.gov.uk/network/18/files/2013/03/Statutory-Guidance-on-Joint-Strategic-Needs-Assessments-and-Joint-Health-and-Wellbeing-Strategies-March-20131.pdf 31

  32. Back to home Foundation Trusts The Health and Social Care Act 2012 has put in place the following freedoms for NHS Foundation Trusts; • Greater operational freedom to organise services that deliver better care for patients. Greater opportunity to develop more innovative services – taking advantage of greater flexibility around private income so it best supports the Trust’s NHS activity. The ability to merge with, or acquire, other NHS foundation trusts and NHS trusts without the explicit approval of Monitor, and without a burdensome legislative process. • Genuine operational independence to determine how best to meet the needs of commissioners. Monitor will cease to have a role focused solely on the performance of foundation trusts, and instead will regulate all healthcare providers to ensure they remain financially sound and well governed. Monitor, working with the NHS Commissioning Board, instead of ministers, will set the national tariff from 2014/15, giving long-term stability in planning income to maximise the operational independence given by the Act. • The Act prevents the Government – or anyone else in the NHS – from discriminating against Foundation Trusts in favour of the private sector. All NHS Trusts are working towards Foundation Trust status by April 2014. Information from:Letters from Secretary of State for Health April 2012 to NHS Foundation Trust and NHS Trust CEOs: http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_133419 32

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