Working Together

1. Working Together Putting change into practice Chris Easton, Personalisation Specialist, NHS England 27th September 2013

2. The imperatives for change The MUSTS The SHOULDS HOW? NHS | Presentation to East Midlands Pathfinders 27th September 2013

3. What NHS England does Patient-focused, clinically-led organisation that has the culture, style and leadership to truly improve outcomes for patients • To allocate resources to clinical commissioning groups (CCGs) • To support CCGs to commission services on behalf of their patients (according to evidence-based quality standards) • To have direct responsibility for commissioning services: • primary care; • military and prison health services; • high secure psychiatric services; and • specialised services. NHS | Presentation to East Midlands Pathfinders 27th September 2013

4. Our ways of working • A nationwide organisation • Matrix working at the heart - to provide simplicity, aid efficiency and ensure singularity of approach • We intend to ensure that everything that NHS England does: • contributes to improving outcomes; • has been clinically-led; • promotes equality and supports a reduction in health inequalities; • is informed by the needs, views and wishes of patients and the public; and • promotes innovation and puts research into practice. NHS | Presentation to East Midlands Pathfinders 27th September 2013

5. NHS England structure • Area teams – commissioning high quality primary care services, supporting and developing CCGs, assessing and assuring performance, direct and specialised commissioning, managing and cultivating local partnerships and stakeholder relationships, including representation on health and wellbeing boards • Four regions - providing clinical and professional leadership, co-ordinating planning, operational management and emergency preparedness and undertaking direct commissioning functions and processes within a single operating model • National support centre in Leeds and a presence in London NHS | Presentation to East Midlands Pathfinders 27th September 2013

6. NHS England Patient and Public Voice and Insight • NHS England places significant emphasis on putting patients at the absolute heart of their healthcare; • Collective voice • Citizen’s Assembly • Children and Young People’s Health Forum • Strong VCS partnership • Participation guidance for CCGs • Patients in Control (Individual Participation) • Self care and self management • Person centred support planning • Personal health budgets NHS | Presentation to East Midlands Pathfinders 27th September 2013

7. NHS England Patient and Public Voice and Insight • Insight • Friends and Family Test • Patient Centred Outcomes Measures (PCOMS) • Patient Survey Programme • Insight Dashboard NHS | Presentation to East Midlands Pathfinders 27th September 2013

8. The NHS and Personal Health Budgets • CCGs have very clear mandate commitments to ensure that personal health budgets are available to people who would benefit: • With continuing healthcare funding by April 2014; • With any long term condition by April 2015; • In reality this represents a relatively small cohort for each CCG • There is a National Delivery Programme that supports CCGs with implementation and we are exploring specific support for children’s PHBs NHS | Presentation to East Midlands Pathfinders 27th September 2013

9. Other commitments The NHS mandate is explicit in expecting improvements in: • Care that is coordinated around the needs, convenience and choice of patients, their carers and their families; • Centres on the person as a whole rather than a single condition; • Ensuring people experience smooth transition between services, agencies and life stages; • Empowering service users; NHS | Presentation to East Midlands Pathfinders 27th September 2013

10. Specifically for children with SEN “One area where there is a particular need for improvement, working in partnership across different services, is in supporting children and young people with special educational needs or disabilities. NHS England’s objective is to ensure that they have access to the services identified in their agreed care plan, and that parents of children who could benefit have the option of a personal budget based on a single assessment across health, social care and education.” NHS | Presentation to East Midlands Pathfinders 27th September 2013

11. Focusing on a system that works for families • Services that build around a child, irrespective of boundaries and don’t compartmentalise need; • Services viewed in the context of people’s lives and their contribution to them, not the other way round; • Services that are flexible, personalised and meet family need; • More streamlined assessment and review – services that talk to one another and work effectively together; • Services that respond to variations and are there when families need them; • Involved/engaged in their care and support at a level that suits them, having different conversations, doing with rather than doing to; NHS | Presentation to East Midlands Pathfinders 27th September 2013

12. Focusing in a system that works for families • Services that are commissioned with family voice at the centre; • Reducing adversary and moving towards partnership with services and professionals; • Not having to retell their story, a single narrative, a single plan; • Being clear about how to get support and where to go for it; NHS | Presentation to East Midlands Pathfinders 27th September 2013

13. How might we make it happen? • The principal driver for change can’t be legislative commitments (although they are useful), it must be a relentless drive to improve outcomes and experience for families; • Powerful and representative family voice – a pivotal part of commissioning; • In the NHS although the most tangible commitments relate to PHBs and care planning etc, this, to be genuinely effective needs to be underpinned by a personalised system – building around the family, not expecting families to fit into it; • Strong leadership and clear strategic direction from health and wellbeing boards and senior leadership in health, education and social care; NHS | Presentation to East Midlands Pathfinders 27th September 2013

14. How might we make this happen? • Joint governance, effective joint funding arrangements that allow us to think about the whole child and not just their discreet needs; • Agencies that work collaboratively and on an equal footing. This mustn’t be perceived or applied locally as an education agenda; • A workforce that believes in the critical concepts that underpin these reforms; • Frontline staff empowered to have different conversations with families and arrive at creative, personalised solutions; • Integrated outcomes and performance management – a system that Measuring success based on outcomes, not on quantity of service received; NHS | Presentation to East Midlands Pathfinders 27th September 2013

15. How might we make this happen? • Integrated data and intelligence – high quality information to underpin commissioning – tools such as the JSNA need to have robust and useful information relating to disabled children; • How do we create synergy across the commissioning system for children and young people?; • Different relationships with health in a new system that has undergone phenomenal change; • Strong relationship with the VCS; • A culture change amongst families – but need to be aware of why families have mistrust of services, leading to a change in the currency of success; NHS | Presentation to East Midlands Pathfinders 27th September 2013

16. NHS | Presentation to East Midlands Pathfinders 27th September 2013

17. Contact Details Chris Easton Personalisation and Control Specialist NHS England Chris.easton1@nhs.net NHS | Presentation to East Midlands Pathfinders 27th September 2013