Equity and Excellence: Liberating the NHS

1. Equity and Excellence: Liberating the NHS Marion Dinwoodie Chief Executive NHS Medway Briefing for Children’s Trust Board 21 September 2010

2. White paper headlines • Putting patients and the public first “No decision about me, without me” • Focus on improvement in quality and healthcare outcomes • Autonomy, accountability and democratic legitimacy • Cutting bureaucracy and improving efficiency • £20bn by 2014 reinvested to support quality and outcomes • Reduction of 45% in NHS management costs over four years

3. White paper headlines 2 • Independent and accountable NHS Commissioning Board • Power and responsibility for commissioning devolved to GP consortia, accountable to the NHS Commissioning Board • Local Authorities to promote joining up of local NHS services, social care and health improvement • Ring-fenced Public Health Budget • HealthWatch funded by and accountable to local authorities • Monitor will be economic regulator • Strengthened role of CQC in health and social care

4. Timetable • Shadow NHS Commissioning Board established as a special health authority from April 2011 • Commissioner/provider split completed by April 2011 • Independent NHS Commissioning Board fully established by April 2012 • GP consortia established in shadow form from 2011/12 • Autumn 2012 NHS Commissioning Board makes allocations for 2013/14 direct to GP consortia • April 2013 GP consortia hold contracts with providers • SHAs will no longer exist from 2012/13, PCTs from April 2013

5. Consultation process • Consultation process ends 11 October • Consultation will: • Involve public, patients, GPs, health and social care professionals, local gov, voluntary and independent sector • Be carried out in partnership with external organisations • Look to models of good practice • Inform the development of Impact Assessments to be published later in 2010 • Examples of existing practice and evidence that supports respondents’ views are encouraged • The government will publish a response prior to the introduction of a Health Bill later this year

6. Consultation documents • Consultation documents published to date • Commissioning for patients • Local democratic legitimacy in health • Freeing providers and economic regulation • The NHS Outcomes Framework • Documents to come • HR framework • Information strategy • Workforce Planning • Education and training • Accessing cancer drugs • Extending and expanding choice • Public Health White Paper published later in 2010

7. The role of PCTs during transition • Support and enable the new GP consortia • Deliver the QIPP agenda • Build relationships with the new patient and public arrangements (local HealthWatch) • Engage with clinical leaders and partners to build support and understanding for the changes • Work with Local Authorities and other social care partners to manage financial and service pressures • Work to ensure the sustainability of key systems and processes through the transition period

8. GP consortia • Authorised and held to account by the NHS Commissioning Board • Consortia will work closely with secondary care, health and care professionals and community partners to design joined-up services • Not all GPs will need to be actively involved, a small group could lead the consortium and clinical design of services • Consortia can employ staff or buy in external support, e.g. to analyse health needs, manage contracts and monitor spend and outcomes • NHS Commissioning Board will develop commissioning guidelines, model contracts and tariffs

9. GP consortia responsibilities • Responsible for commissioning the great majority of services including: • Elective hospital care • Rehabilitative care • Urgent and emergency care • Out of hours services • Most community health services • Mental Health • Learning Disability services

10. GP consortia responsibilities • Consortia won’t commission primary medical services but will be influential in driving up quality and can commission enhanced services • NHS Commissioning Board will commission primary medical care, dentistry, pharmacy, ophthalmic, maternity, prison and specialist national and regional services • Consortia have a duty to promote equalities, work with Local Authorities and engage and involve public and patients • Consortia will develop their own arrangements to hold constituent practices to account

11. GP consortia funding • Local Authorities may, where agreed, support joint commissioning and pooled budget arrangements • NHS Commissioning Board will calculate practice-level budgets and allocate to consortia • Budgets will be separate from GP practice income but some could be linked to outcomes and management of resources • Consortia must ensure spend does not exceed allocated resources • Consortia will hold contracts with providers and hold them to account for quality standards and outcomes

12. Accountabilities • NHS Commissioning Board will develop a commissioning outcomes framework to make information available to the public on: • Quality of healthcare services • PROM measures (Patient Recorded Outcome Measures) • Management of resources • Progress in reducing health inequalities • NHS Commissioning Board will have powers to intervene if consortia are ineffective or there is significant risk of failure • Criteria/triggers for intervention will be developed

13. Local democratic accountability in health: The role of Local Authorities • Take the lead in joint strategic needs assessments across health and local government services • Promote joint commissioning between GP consortia and Local Authorities • Take the NHS constitution into account when influencing commissioning decisions about NHS service • Support local voice and the exercise of patient choice • Further integrate health with adult social care, children’s services (including education) and wider services including disability services, housing, tackling crime and disorder • Lead on local health improvement and prevention activity

14. Changes to Public Health • Public Health White Paper to be published late 2010 • By April 2012 national Public Health Service in place with a lead role on public health evidence and analysis • Ring-fenced budget and local health improvement led by Directors of Public Health jointly employed by local authorities and the Public Health Service • Arrangements to support shadow health and wellbeing partnerships begin April 2011 • Local authority health and wellbeing boards in place by April 2012 • Ring-fenced budget reflecting local health outcomes and health inequalities

15. Strengthened integration • Government to explore benefits of place-based budgets for areas, e.g. older people’s services and substance misuse • Extended availability of personal budgets in the NHS and social care, with joint assessment and care planning • Quality standards across patient pathways, e.g recently published NICE dementia standard • CQC as effective inspector of quality standards spanning health and social care • Payment systems to support joint working, e.g. payment by results and hospital readmissions • Providers freed up to innovate, e.g. foundation trusts could expand into social care

16. Health and wellbeing boards • Statutory board is government’s preferred option, subject to consultation • “Minimal requirements, maximum freedom and flexibility” • Replaces current Health Partnership Boards and OSCs • Would bring together mix of elected members and officials including Council Leader, Social Care, Public Health, NHS Commissioners, GP consortia, local government and patient champions • Voluntary sector, other public services and providers can be invited to participate • Chair to be decided by elected members • NHS Commissioning Board will attend when relevant

17. Health and wellbeing boards 2 • Promotes integration and partnership working between the NHS, social care, public health and other local services • Assesses local need, leads joint strategic needs assessment for coherent and co-ordinated commissioning strategies • Determines strategy and allocation of place-based budgets • Supports joint commissioning and pooled budget arrangements where all parties agree this makes sense

18. Health and wellbeing boards 3 • Resolves or escalates to national NHS Commissioning Board concerns about local partnerships, e.g. children’s safeguarding • Has strategic oversight of health and social care services • Resolves concerns about service changes and scrutinises major service redesign • Has a role in enabling NHS Commissioning Board to assure itself that GP consortia are responsive to patients and public

19. Role of HealthWatch • A more powerful and stable “local consumer champion” for health and social care • Will sit on Health and Wellbeing Boards • Continues to promote patient and public involvement and seek views on local health and social care services • Becomes a “citizen’s advice bureau” for health and social care, providing a signposting function • Supports individuals to exercise choice, e.g. choice of GPs

20. Role of HealthWatch 2 • Commissioned by Local Authorities to provide an NHS complaints advocacy service (currently provided by the Independent Complaints Advocacy Service) • Can be replaced by Local Authorities in the event of under performance • Can report concerns about provision of local NHS or social care services to HealthWatch England, independently of host Local Authority

21. The NHS Outcomes Framework • Sets out how the Secretary of State will hold the NHS to account • Focus at a national level is on outcomes of care… locally structures and processes of care will also need to be monitored • Will act as a catalyst for driving up quality …not as a tool to performance manage providers • NHS Commissioning Board will determine how best to deliver improvements using: • Quality Standards from NICE • Payment mechanisms and incentive schemes such as CQUINs • Set of indicators to “operationalise” the national outcome goals • Commissioning framework for GPs

22. Accountability and transparency • NHS Outcomes Framework data will be publicly available • Balanced set of outcomes will be chosen to hold NHS Commissioning Board to account, spanning Effectiveness, Patient Experience, Safety • The outcome measures will cover clinical outcome measures as well as PROMS • Will recognise importance of reducing inequalities and promoting equality • Outcomes will be measured by different equalities characteristics and by local area

23. Structure of the Framework • NHS Outcomes Framework to be developed around five outcome domains: • Preventing people from dying prematurely • Enhancing 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 • Each domain will have an overarching set of indicators • Over 5 years NICE will develop 150 quality standards

24. DRAFT 10/8/10 What happens next? NHS Medway Board Transition Board (MD - Chair, S.Gee, WH, AB, PG, HB, Neil Davies, LINk, PB, JB, LK, ND, other GPs) GP Consortia (PG) LA Transition (AB-Chair, HB, LA Rep) TCS (MD-Chair, WH) Inventory of current functions (WH) General (WH) Scrutiny of Service Reconfiguration (ND) Organisation Form (ND) Public Health (AB) Health Improvement (SAI) Safeguarding/ Quality (PB) Estates, IT, Infrastructure (JB) EP (ND,AB) Communications (NY) Early Years (SM) Integrated commissioning (LK, HB, LA rep) OD Clinician GPs, WH Finance (JB) LA Relationship (HB, LA Representative) Dispute Resolution (HB, LA rep) New role of LINk, PALS, Complaints (ND) People / Workforce (WH) Handover to successor organisations (ND) Next Steps Plans / timescales Work Group members; Staff, GPs Work assumptions – look to future Communications to organisation

25. Thank you Any Questions?