The Kent Health Commission in Dover

1. The Kent Health Commission in Dover Paul Carter Leader of Kent County Council

2. Kent Health Commission As health and social care commissioners, to develop a visionary model that demonstrates how the Government’s health and care reform agenda can empower GPs and commissioners to deliver better quality care, improve health outcomes and improve patient experience through working with GPs in Dover district as a pilot area.

3. Tonight’s Meeting • Second meeting of Health Commission • Follows wide-ranging discussion with GPs on 17th November • Further meeting scheduled in House of Commons on 8th December, chaired by Charlie Elphicke MP • Opportunity tonight to discuss with PCT and major health care providers the issues arising from the “Kent Health Commission” to date and the implementation of the reform agenda in Kent

4. AQP The Brave New World Kent Health and Wellbeing Board Commissioning in Kent: 8 x CCG’s Kent Social Services NHS Commissioning Board Service Specification Potential Providers: KCHT KMPT EKHUFT Social Services Voluntary Sector Private Sector

5. Feedback from first Round Table with GPs (17 Nov):Some new opportunities, some ”wicked issues” General optimism that the system can be improved, but views that… • We’ve seen it all before…inertia? • It’s already being done to us…to late to change? • There’s no real service/provider choice…the same old, same old...? Are clinically driven ambitions being lost in managerial process?

6. So, how do we: • Work together to unlock and deliver improved choice and care, doing more with the same money? • Redirect resource to fund greater choice in prevention, support and enablement in an new model of community health provision? • Encourage acute hospital trusts to be part of the solution in community health How do we work together to deliver “a different shaped sponge”! (ie real change)

7. The Birth of CCGs • Is CCG authorisation an issue in Kent? • Or is there a risk of further changes to configuration? • How do we strengthen the link between Primary clinician to Acute clinician? • ie How do we ensure management bureaucracy does not get in the way? • Are the Health and Wellbeing Board and Joint Strategic Needs Assessment going to be drivers for change? • Are there new and/or innovative models of supporting commissioning by CCGs (eg HR, Finance, IT, etc)? • Could local government support CCG development and CCG commissioning for outcomes? Will CCGs have a ‘real’ choice?

8. PCT: A Managed Withdrawal • What staff are transferring to CCGs (or NHS Commissioning Board)? What disciplines do they have? • Is there a redundancy pot? • Do CCGs have a choice in who they take on (or done to)? • How are 40% management savings being achieved within the PCT Cluster? • How will CCGs manage with £25 commissioning support budget per head of population (previously c £40)? • Is there a wider market in commissioning support (e.g. private sector or local government) for CCGs that might drive down costs? • Is there a free market or compulsion? Does the process offer a short-term agreement for CCGs or a long- term tie in?

9. So how does the new provider landscape look? • Providers or brokers? • KCHT, KMPT, Acute Trusts, Social Care, etc • What will the new relationships (eg with Acute Trusts) look like? • Where should “single assessment” take place? • eg CHT/Social Care or CCG/GP surgery? • Will AQP restrict CCG commissioning role or further enhance it? • What will be the impact of AQP on CCG ability to build relationships and solutions with particular providers? • What services and commissioning need protecting at County level and nationally (NHS Commissioning Board)?

10. The Patient Journey • Are there perverse incentives to resolve individual symptoms rather than a whole, holistic approach to the patient – Lean Modelling of patient journey. • How do we strengthen pathways between primary, community and acute (e.g. back and front ends of hospitals) to smooth patient care? • Who is accountable for patient outcomes? What could the new world look like? Better patient care - Better patient outcomes

11. We are not alone… “The week before last, I had over 30 emails from concerned CCG leaders. Each told its own story; stories of commissioning support being imposed, of staff being appointed without consultation and of crucial meetings being arranged with less than twelve hours' notice. if we really want a locally sensitive NHS then, in future, there must be no “top”.  No “bottom”.  Just centre and frontline.  Both looking out to our patients rather than simply feeding the system.  It must not only be like that it must feel like that.  I do believe that the centre now genuinely wants to devolve power and responsibility.”  Dr Michael Dixon, Chair NHS Alliance and GP

12. Programme 7.15 Ann Sutton, Chief Executive, NHS Eastern & Coastal Kent 7.40 Stuart Bain, Chief Executive, East Kent Hospitals University NHS Foundation Trust and Nicholas Wells, Chairman, East Kent Hospitals University NHS Foundation Trust 8.05 Marion Dinwoodie, Chief Executive, Kent Community Health NHS Trust and David Griffiths, Chairman, Kent Community Health NHS Trust 8.30 Andrew Ling, Chairman, Kent and Medway NHS and Social Care Partnership Trust and Bob Deans, Chief Executive, Kent and Medway NHS and Social Care Partnership Trust