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Visual Guide to the Health and Social Care Act 2012

A visual adaptation of the Health and Social Care Act 2012, providing an overview of the Act and its supporting documents. Includes clickable links to additional information.

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Visual Guide to the Health and Social Care Act 2012

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  1. North of England Mental Health Development Unit Health and Social Care Act 2012 Local Democratic Legitimacy in health The review of arms length bodies Regulating Healthcare providers 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. This document does not cover proposals for the NHS Trust Development Authority or Health Education England. PJ-MJ/April 2012/Version 5 This is a very brief overview of the Health and Social Care Act 2012 and related policy 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 10 NICE 9 Public Health England 12 CQC 13 Health Watch England 14 Monitor 15 Office of Fair Trading16 Commissioning outcomes framework 17 Local Health Watch 24 Public Health 22 National and Regional Specialist Commissioning 18 Clinical Commissioning groups 19 Health & Wellbeing Boards 27 Local Authority 21 Foundation Trusts 29 Commissioning Support Services 20 JSNA + Joint Health and Wellbeing Strategy 28 Independent sector Patients carers and the public 2

  3. The NHS Outcomes Framework 2012/13 The NHS Outcomes Framework sets out the outcomes and corresponding indicators that will be used to hold the NHS Commissioning Board to account for the outcomes it secures through its oversight of the commissioning of health services from 2012/13. The indicators used to hold NHS organisations to account during 2011/12 were set out in The Operating Framework for the NHS in England in 2011/12 which provided the financial, business and planning rules that support the delivery of NHS priorities. • For 2011/12, where data was available, this was used to identify baselines. 2011/12 was also used to negotiate levels of ambition with the shadow NHS Commissioning Board, in light of the NHS settlement following the 2010 Spending Review. • In 2012/13, the framework will be used by the Secretary of State for Health to hold the NHS Commissioning Board to account and for achieving levels of ambition where they have been agreed. The Framework will also support the integration of NHS, public health and adult social care outcomes. Continued on next page

  4. NHS Outcomes Framework continued... The NHS outcomes framework is made up of five domains and the following diagram illustrates how each domain influences the NHS quality improvement system Back to home 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 NICE Quality Standards (Building a library of approx 150 over 5 years) Provider payment mechanisms Commissioning Outcomes Framework Commissioning Guidance tariff Standard contract CQUIN QOF Commissioning/Contracting NHS Commissioning Board – certain specialist services and primary care Clinical Commissioning Groups – all other healthcare services NHS Outcomes Framework information taken from: The NHS Outcomes Framework 2012/13 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_131724.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 Transparency in outcomes: a framework for adult social care 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 and support • Safeguarding adults whose circumstances make them vulnerable and protecting from avoidable harm These outcomes, combined with other resources such as the Adult Social Care Survey, will inform the ‘local account’, which is a new way for councils and local communities to have a more detailed and meaningful dialogue. The local account will replace previous annual publications by the Care Quality Commission. To further support the closer alignment of the ASCOF with the NHS Outcomes Framework and the Public Health Outcomes Framework, in future years, the ASCOF will be published in the autumn of the preceding year, beginning with the publication of the 2013/14 framework in autumn 2012. View overlapping outcome frameworks diagram Information taken from: Transparency in outcomes; a framework for quality in adult social care http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_133335.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 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_123113.pdf

  9. 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. Information on NICE quality standards can be found at: http://www.nice.org.uk/aboutnice/qualitystandards/qualitystandards.jsp 9

  10. Role of the NHS Commissioning Board • The NHS Commissioning Board will be established as an independent body, at arms length to the Government, by October 2012. Initially, it will carry out limited functions such as establishing and authorising Clinical Commissioning Groups. • The Board will take on its full range of responsibilities, and the new commissioning system will begin to operate, once it is fully established from April 2013. 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; • 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. Back to home 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 10

  11. 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

  12. Back to home Public Health England Public Health England will be created in 2012, taking on full responsibilities from 2013. Public Health England will be established as an Executive Agency, within a structure accountable to the Secretary of State for Health, and bringing together the functions of the current: • 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 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_122347.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 will be established in October 2012 as the new consumer champion for health and adult social care in England. For the first time this will clearly provide a platform for making the NHS and local government accountable to their local communities, people using care and carers to have their voices heard at a local and national level. 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 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 lawapplies 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. Commissioning Outcomes Framework The NHS Commissioning Board, supported by NICE and working with professional and patient groups, will develop a Commissioning Outcomes Framework (COF) that measures the health outcomes and quality of care (including patient reported outcome measures and patient experience) achieved by clinical commissioning groups. The COF will allow the NHS Commissioning Board to identify the contribution of clinical commissioning groups to achieving the priorities for health improvement in the NHS Outcomes Framework, while also being accountable to patients and local communities. It will also enable the commissioning groups to benchmark their performance and identify priorities for improvement. The NHS Commissioning Board is engaging with clinical commissioning groups and patient and professional organisations to develop emerging proposals for the COF. Indicators are being developed either derived directly from the NHS Outcomes Framework; based on NICE Quality Standards; or from other sources to support the NHS Outcomes Framework. Publication of the NICE menu of indicators for the COF is anticipated for summer 2012. Back to home Commissioning Outcomes Framework information taken from the NICE website: http://www.nice.org.uk/aboutnice/cof/cof.jsp 17

  18. National and Regional Specialist Commissioning Specialised services are defined in law as those services with a planning population of more than one million people. This means that a specialised service would not be provided by every hospital in England; generally, it would be provided by less than 50 hospitals.The Specialised Services National Definitions Set describe these services in more detail. Specialised Mental Health Services (all ages) Definition: Specialised Services for eating disorders Forensic / Secure Mental Health Services. Specialised Mental Health Services for the Deaf Gender Dysphoria Services Perinatal Mental Health Services (mother and baby units) Complex and/or Refractory Disorder Services. Specialised Services for Asperger’s Syndrome and Autism Spectrum Disorder Tier 4 Severe Personality Disorder Services. Neuropsychiatry Services Tier 4 Child and Adolescent Mental Health Services. Back to home Mental Health Specialist Commissioning information taken from: Third edition of the Specialised Services National DefinitionsSet http://www.specialisedservices.nhs.uk/library/26/Specialised_Mental_Health_Services_all_ages.pdf 18

  19. Back to home Clinical Commissioning Groups By April 2013 the whole of England will need to be covered by established Clinical Commissioning Groups (CCGs). CCGs will be responsible for commissioning a range of services, currently 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 have been identified, broadly grouped into six domains: • 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. To be fully authorised CCGs should be able to demonstrate an adequate level of competence across all of these areas and the potential to achieve excellence in the future. All GPs are required to become 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 19

  20. Back to home Commissioning Support Services Discussions with stakeholders confirm that commissioning support is one of the most fundamental and challenging parts of the reforms. Local and national Commissioning Support Services (CSS) are being designed to offer an efficient, locally-sensitive and customer-focused service to CCGs. CCGs are likely to need support in carrying out both the transformational commissioning functions, like leading change and service redesign, and the more transactional commissioning functions, such as procurement, contract negotiation and monitoring, information analysis, and risk stratification. CCGs will always retain legal accountability and responsibility for meeting their statutory functions and their commissioning decisions cannot be delegated. Early indications suggest there will be around 20-25 local CSS hosted by the NHS Commissioning Board in the first instance. Some CSS are already up and running and supporting the 2012-13 NHS business planning round. The new CSS will be designed to be effective in a competitive marketplace and will be set up to give CCGs access to the best possible processes, services and products to enable efficient and evidence-based commissioning. CSS leaders will be responsible for developing these new organisations to be confident, customer-driven organisations that are capable of being independently sustainable within the competitive marketplace in no later than three years. Commissioning Support Services information taken from: Commissioning Support Key Facts: http://www.commissioningboard.nhs.uk/files/2012/02/01-Commissioning-Support-Key-Facts-Sheet-Feb-2012-web-version.pdf

  21. 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 21

  22. 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. Continued on next page Information taken from: Healthy Lives, Healthy People: Our strategy for public health in England http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_122347.pdf

  23. Back to home Public Health continued… Key public health milestones in 2012/13 April 2012 – PCTs with local authorities to agree plans for the transfer of public health functions and teams to local authorities Spring 2012 – DH will publish a consultation on a public health workforce strategy Spring 2012 – appointment of chief executive designate and agree Public Health England (PHE) structures Early summer – all local areas will agree on the vision and strategy for the new public health role in local authorities Summer 2012 – publication of full People Transition Policy (PTP) and establish the PHE staff transfer process Autumn 2012 – publication of public health workforce strategy April 2013 – Public Health England will be created April 2013 – local authorities will take on new public health responsibilities Information taken from: The Month: March 12, Special Issue 52 http://www.dh.gov.uk/health/files/2012/03/The-month_Mar-12_FINAL1.pdf

  24. 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

  25. 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/files/2012/03/Local-Healthwatch-policy.pdf Continued on next page

  26. 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

  27. 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. Over the next year, shadow boards will continue to work towards readiness for their statutory responsibility - undertaking joint strategic needs assessments and joint health and wellbeing strategies as the foundation for 2013/14 commissioning plans, but also looking at how they can take joint action now ahead of 2013 for example on bringing together services through joint commissioning. Statutory health and wellbeing boards will have four main functions: • to assess the needs of the local population and lead the statutory joint strategic needs assessment; • to promote integration and partnership across areas, including through promoting joined up commissioning plans across the NHS, social care and public health; • to support joint commissioning and pooled budget arrangements, where all parties agree this makes sense; and • to undertake a scrutiny role in relation to major service redesign Back to home 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 27

  28. Joint Strategic Needs Assessment (JSNA) and Health and Wellbeing Strategies A joint strategic needs assessment (JSNA) is an assessment of the health and wellbeing needs of the population in a local area. JSNAs aim to establish a shared, evidence based consensus on key local priorities to support commissioning to improve health and wellbeing outcomes and reduce inequalities. Since 2007 it has been a statutory duty for primary care trusts and local authorities to undertake JSNAs; in future Health and Wellbeing Boards will be required to lead enhanced JSNAs, as well as new joint health and wellbeing strategies (JHWS) which will be informed by the needs and assets identified through the JSNA. This requirement will: Support commissioners to decide on priorities in a more joined-up, effective and efficient way; Provide a coherent single needs assessment for all services which will identify the scope for contributions from a wide range of influences such as housing, economic development, spatial planning etc, through Health and Wellbeing Boards; Strike the right balance between facts and figures about local health and wellbeing, and local views about what should be done, through local democratic accountability and HealthWatch. There is a new shared statutory obligation on GP-led clinical commissioning groups and the local authority (through the health and wellbeing board), to produce JSNA and JHWS and to commission with regard to them. In doing this, they must consider the use of flexibilities under the NHS Act 2006, such as pooled budgets. The NHS Commissioning Board will also be expected to have regard for both JSNA and JHWS. Back to home Information on Joint Strategic Needs Assessments and Health and Wellbeing Strategies can be found at: http://www.idea.gov.uk/idk/aio/27115491andhttp://www.idea.gov.uk/idk/aio/27014541 28

  29. 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 29

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