Equity and excellence: Liberating the NHS

1. Equity and excellence: Liberating the NHS David Williams Director of Commissioning

2. Vision • • Centred on patients and carers; • • Achieves quality and outcomes that are among the best in the world; • • Refuses to tolerate unsafe and substandard care; • • Eliminates discrimination and reduces inequalities in care; • • Puts clinicians in the driving seat • Sets hospitals and providers free to innovate • Transparent, with clearer accountabilities for quality and results;

3. Vision • Gives citizens a greater say in how the NHS is run; • Less insular and fragmented, and works much better across boundaries, including with local authorities and between hospitals and practices; • More efficient and dynamic, with a radically smaller national, regional and local bureaucracy; and • More stable and sustainable footing, free from frequent and arbitrary political meddling.

4. Regulation • Economic Regulator: Monitor regulating competition, setting prices and supporting continuity of service • CQC to focus on inspection (min standards) • NICE to develop 150 standards • Demand Side • Abolition of PCTs and SHAs and “PBCs” • Creation of NHS Commissioning Board • Creation of statutory GP Consortia • Extend choice: no decision about me without me • Health improvement duties transfer to LAs, under DPH with Health and Well-being Boards • Supply side • All Trusts to be FTs by April 2013 • FT private patient cap to be removed • Ability to form Social Enterprises • Any willing provider model in all services • Goals and payments • £20Bn efficiency savings & mgt costs down 45% by 2014 • NHS Outcomes framework: national outcome goals, to be translated into GP Consortia objectives • Board defines structure of payment systems: Regulator sets tariff to include quality measures Liberating the NHS – the headlines

5. The role of GP Consortia • Consortia of practices working in partnership with local authorities and communities responsible for commissioning majority services • Statutory - - not optional, practice agreements GP contract change accountable officer Size, geography • Duties – equality, outcomes, public patient involvement • GP Consortia will decide what support services • They will receive a management allowance

6. NHS Commissioning Board • Provide leadership for quality improvement • Setting guidelines for improving standards • Design model contracts • Design structure of tariff • Promoting and extending patient choice and involvement • Development of GP consortia • Hold consortia to account • Commissioning certain services • GP, dentistry, community pharmacy, primary ophthalmic, maternity services, specialised • Allocating and accounting for NHS resources

7. Improving Public Health White paper December 2010 new public health service Joint DPH LA and public health service Joint strategic needs assessment Health improvement budgets (eg. weight management, smoking cessation, promotion and prevention) UA responsible for population health outcomes

8. Health and Well-being Boards • Key mechanism to support democratic legitimacy • Support, promote partnerships and integration • Scrutiny role for major service redesign • Lead on JSNA and public health priority setting • Consist of local representatives, elected councillors, Directors of Social Care, GP consortia, Healthwatch, DPH

9. Healthwatch • Champion users and carers • Voice for patients locally • Information to improve accountability • National structure • Represent patients and the public and provide independent evidence of local services • Representative on Health and Well-being Board

10. Timelines 2010/11 • October 2010 Consultation ends:- • Liberating the NHS; Equity and excellence • Increasing democratic legitimacy in health • Commissioning for patients • Regulating healthcare providers • Transparency in Outcomes: a framework for the NHS • December 2010 - Public Health White Paper • January 2010- Social Care Proposals

11. Timelines

12. What are we doing locally? • Ensuring we deliver £100m efficiencies in the next four years whilst improving quality (QIPP) • Discussing shape and size of GP consortia in preparation for ‘shadow’ consortia April 2011 • Engaging with boroughs on joint plans for change – RBWAM project group • Working through transition plans at JSCB- September 2010 • Preparing for OD processes and transition plans

13. ‘Transparency in outcomes; a framework for the NHS’ • EFFECTIVENESS • PATIENT EXPERIENCE • SAFETY • Preventing people from dying prematurely • Enhancing the 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 • Outcome Areas, Specific Improvement Areas, Quality Standards (NICE-150)