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‘Liberating the NHS’ Implications of the NHS White paper

‘Liberating the NHS’ Implications of the NHS White paper. Ian Holmes Associate Director, Economics and System Management. The case for change. “Health outcomes lag behind much of Europe Inequalities have not narrowed Services are unresponsive and place low value on “customer care”

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‘Liberating the NHS’ Implications of the NHS White paper

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  1. ‘Liberating the NHS’Implications of the NHS White paper • Ian Holmes • Associate Director, Economics and System Management

  2. The case for change • “Health outcomes lag behind much of Europe • Inequalities have not narrowed • Services are unresponsive and place low value on “customer care” • “Big government” has failed to prevent safety scandals • Big money has seen more waste and lower productivity • Dependency on buying change is no longer an option” So …

  3. Key aspects of the changes The NHS should focus on the outcomes that matter to patients and communities - Process targets to be replaced by an outcomes framework Competition and choice used to drive quality and respond to local needs

  4. Key aspects of the changes GPs and patients should make decisions on how to improve health and outcomes together – Information – choice is only effective if made from a position of knowledge about alternatives GP commissioning – aligning decision making with the people closest to the patientPCT abolition – PCTs ‘abolished by the end of 2012-13.

  5. Key aspects of the changes Improvement in healthcare has been held back by political interference and too much bureaucratic control–Independent NHS commissioning board - Abolition of SHAs - Abolition of Audit Commission. - A regulatory approach replacing a system management approach.

  6. Key aspects of the changes Knowledge and spending power should be aligned with responsibility and accountability: –GP Commissioning- Specialist and maternity commissioning with NHS board

  7. Key aspects of the changes Greater competition between providers will lead to more rapid improvement in quality and efficiency: –Level playing field overseen by economic and quality regulation- Full separation of commissioning and provision functions- A failure regime – and protection of essential services.

  8. Key aspects of the changes Strategic decisions will work better with local ownership: –New health and wellbeing boards located in local government- Local government responsible for JSNA

  9. Key aspects of the changes We have failed to make sufficient progress on health inequalities: –New national public health service- Ring fenced health promotion funds- Integration of DsPH roles into local government

  10. Some key issues – Choice and AWP • Choice and AWP is key for the effective functioning of competition ‘within’ the market. • Without effective choice and patient switching, organisations with good quality services are not rewarded and those with poor services are not penalised. • Key issues: • - How successful has choice been so far - why? • - Are there incentives for GP commissioners to offer choice in the future? • Choice of commissioner is likely to be a reality – what are the implications of this? • Feasibility of applying AWP to more specialist services?

  11. Some key issues – financial failure and service continuity • For the competition to be effective there must be competitive tension – i.e. the incentive to perform driven by the opportunity of gaining or threat of losing income. • In a more competitive, regulated healthcare system with low resource growth some financial failure is inevitable? • Key issues: • Defining a regulatory approach to failure? • Defining ARSs (Protecting ARSs) and ensuring service continuity? • Financial risk pooling and supporting financial resilience? • Creation of provider groups and chains to support resilience?

  12. Some key issues – service resilience SHAs as system managers have a legal duty under the Civil Contingencies Act 2004 to maintain the NHS’s ability to respond to any disruptive challenge. How will this function be delivered in the healthcare system of the future? These duties fall into three key functions: Warning and Informing the Public – led by Communication and media – How will this be led in the future? Management Coordination – Who will be the accountable officer in the future? – This currently being managed through the Regional Health Emergency Planning Executive Group. Protecting the Public – health prevention and health protection The new Public Health Service to consider – national work being undertaken – Green Public Health paper Autumn 2010.

  13. And in the meantime… • Keeping the show on the road: Grip before liberation? • SHAs and PCTs responsible for delivering the majority of the £1.7bn of QIPP savings between now and 2014-15, while maintaining quality and service performance (while reducing management cost by 45%). In 2010-11, the final year of higher funding, our organisations have identified a requirement of £350m efficiency savings, in order to an aggregate surplus of £150m. By 2014-15, the requirement is in the region of £1.77bn if the 2010-11 efficiency requirement is included. Excluding 2010-11, the efficiency requirement is in the region of £1.4bn.

  14. And in the meantime… • SHA appointed Director of Commissioning (Ailsa Claire) to take forward the work to establish GP commissioning arrangements: • GP commissioning • Specialist arrangements • FHS • Maternity • PCT journey • SHA appointed Director of Provision (Steven Michael) to take forward the work on provider development, including: • TCS • FT pipeline • Process for managing remainder of NHS Trusts • Future system design

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